Well and intermediate differentiated laryngeal chondrosarcoma: toward conservative surgery?

Abstract

Chondrosarcoma of the larynx is a relatively rare malignant tumor. In the world literature, only 600 cases of laryngeal chondrosarcoma (LCS) have been reported. It is the most frequent non-epithelial tumor of the larynx (0.07-2% of all cancers), usually occurring on the cricoid. We present six cases of well-intermediate differentiated grade chondrosarcoma of the larynx, diagnosed between the fifth and seventh decades of life, in the absence of relevant risk factors. All cases were subjected to a conservative surgical approach, either endoscopic using remodeling transoral laser surgery, or open neck via a supratracheal partial laryngectomy (STL), sparing laryngeal function. All patients are free from recurrence with a minimum follow-up of 31 months. All were ultimately decannulated, are able to tolerate a quite normal diet and to speak satisfactorily. Conservative laryngeal surgery is effective because chondrosarcoma is often a low-grade tumor showing slow growth. The criteria for choosing the type of surgery was based on the age of the patient (elderly patient > favoring an endoscopic approach), on the rate of involvement of the cricoid and on the involvement of the cricoarytenoid joints (if possible to save a cricoarytenoid unit > favoring a STL). By extending the inferior limit of the resection to include a large part of the cricoid cartilage, supratracheal partial laryngectomies expanded the indications to some LCSs not involving the entire cricoid lamina sparing laryngeal function and avoiding the need for total laryngectomy.