Management Of Laryngeal Cancer Research Articles

Operative techniques in otolaryngology: Head and neck surgery. Geisinger Medical Center experience for whole mount laryngectomy specimen

The American Cancer Society estimates approximately 12,380 new cases of laryngeal cancer (0.7% of all cases) with approximately 3820 people dying from the disease. There is 3.86:1 male to female ratio and represent third most prevalent upper aerodigestive tract site, following the oral and pharyngeal regions. Typically affects patients in the fifth decade of life. Accurate diagnosis and management are crucial for patient survival. This study examines the pathological features of laryngectomy specimens and their significance in the diagnosis and management of laryngeal cancer. Our institution's intraoperative evaluation of margins and surgical procedures for laryngeal cancer treatment are also discussed. The study found that gross pathology and histomorphology of laryngeal specimens after laryngectomy are the most accurate methods for determining the extent of tumor involvement. The majority of our procedures involve total or partial laryngectomy. The significance of surgical pathology in the diagnosis and management of laryngeal cancer is highlighted in this article.

Indian clinical practice consensus guidelines for the management of laryngeal cancer: Update 2022

In laryngeal cancer, the goal of treatment is to achieve maximum cure and preserve function of the larynx with good voice quality. In early disease, transoral laser microsurgery is the preferred choice of treatment. An option for treatment of carcinoma in situ is radiotherapy (RT). In locally advanced laryngeal carcinoma, concurrent chemoradiotherapy (CTRT) is an option. Induction therapy with docetaxel, cisplatin, and 5-flourouracil (TPF), followed by definitive RT or definitive CTRT can be one of the organ preservation approaches for patients undergoing total laryngectomy. For resectable locally advanced disease (T3, N0-3), surgery (laryngectomy with thyroidectomy, ipsilateral or bilateral neck dissection, and pretracheal and ipsilateral paratracheal lymph node dissection) with RT or CTRT should be considered.

The management of advanced laryngeal and hypopharyngeal cancers between years 20202021 single-centre experience

Introduction: Laryngeal cancer is the most frequent neoplasm of the head and neck region. Despite advances in chemo-radiotherapy (CRT), surgery still remains an important role in the management of laryngeal cancer. Laryngeal preservation techniques, including endoscopic laser resection, are becoming more popular nowadays. However, total laryngectomy (TL) remains a reasonable option for advanced disease in selected patients. The main aim of this study was to perform general characteristics of patients with advanced laryngeal and hypopharyngeal cancer treated with TL as well as to perform a detailed analysis of the disease, treatment modalities and complications. Material and methods: This is a retrospective single-centre analysis. Baseline characteristics and preoperative clinical variables were collected. The study group consisted of 42 patients with advanced-stage carcinoma of the larynx and hypopharynx treated with TL between January 2020 and December 2021 at the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland. Preoperative and postoperative clinical variables were collected. Statistical analysis was performed using R software (R version 4.0.3). Results: The mean age of patients at diagnosis was 63.6 +/- 9.2 years, 32 (76.2%) patients were male. The most common symptoms at diagnosis were: hoarseness (78.6%) and dyspnea (47.6%). There was no statistically significant association between symptoms present at diagnosis and the stage of diagnosed laryngeal cancer according to the TNM classification (T3, T4a, T4b). Stage III was observed in 33 (78.6%) patients, IVa in 8 (19%) and IVb in 1 (2.4%) patient. Of the 42 included patients, total laryngectomy was performed in 39 (92.9%) patients and pharyngolaryngectomy in 3 (7.1%) patients. Tracheoesophageal voice prosthesis was implanted in all patients. Complications after surgery were observed in 5 (11.9%) patients. Squamous cell carcinoma was diagnosed in 100% of patients. Complementary therapy was performed in 36 (85.7%) patients. Conclusions: Our study population confirmed that patients suffering from advanced laryngeal and hypopharyngeal cancer are mostly men aged over 60 years with the most common variant of smoking history of over 20 cigarettes per day for a period over 5 years. Symptoms at diagnosis and TNM classification staging of laryngeal cancer are not related parameters.

Outcomes of Laryngeal Cancer Surgery after Open Partial Horizontal Laryngectomies with Lateral Cervical Approach.

Background: Open partial horizontal laryngectomies (OPHL) are one of the surgical techniques used for the conservative management of laryngeal cancers. The aims of this study are to analyze the oncological and functional results of a group of patients affected by laryngeal squamous cell carcinoma (LSCC) treated with OPHL, performed using a minimally invasive technique. Methods: This is a prospective case–control study. We enrolled 17 consecutive patients with LSCC treated with OPHL through a lateral cervical approach (LCA). Patients were evaluated using their Penetration Aspiration Scale score (liquid, semiliquid and solid) and Voice Handicap Index (VHI) at three different endpoints: 15 days (T1), 3 months (T2), and 6 months (T2) after surgery. Results: The functional outcomes of the LCA are stackable with that of the classical anterior cervical approach in terms of respiration, swallowing, and speech. One-way ANOVA was performed to evaluate the variances of PAS and VHI scores at the three different observation points. No statistically significant differences were observed between OPHL- PAS scores for liquid (p = 0.1) at the three different observation points. A statistically significant improvement was observed in the OPHL- PAS score for semisolids and solids (p < 0.00001) between T1 and T3 (p = 0.0001) and for solids between T2 and T3 (p < 0.00001). The improvement of VHI-10 was statistically significative (p < 0.00001) at the three different observation points (T1–T2 and T2–T3). Conclusion: The LCA is a potential approach for laryngeal surgery in selected cases. The preoperative staging and planning are of the utmost importance to ensure oncological radicality. The main advantage of this approach is the preservation of the healthy tissues surrounding the larynx and the functional and oncological outcomes are stackable with the classic anterior cervical approach.

Free Flap microvascular pharyngeal closure results in improved dysphagia-specific quality of life following total laryngectomy

BackgroundTotal laryngectomy (TL) as either a primary or salvage treatment strategy remains an effective oncologic operation in the management of laryngeal cancer. Dysphagia is the most common complication following TL and this has a significant impact on patients’ quality of life (QOL). Following removal of the larynx, a number of pharyngeal closure techniques exist. We aimed to evaluate the effect pharyngeal closure techniques have on dysphagia-specific QOL postoperatively.MethodsWe retrospectively reviewed patients who had undergone TL at our institution (2014–2019). Patients alive at the time of study were invited to complete the MD Anderson Dysphagia Inventory (MDADI). Outcomes were compared among Primary Closure (PC), Pedicled Pectoralis Major Myocutaneous Flap (PMMF) and Free Flap (FF) closure groups.ResultsThere were 27 patients identified for inclusion. Eight patients (30%) underwent PC, 10 patients (37%) had PMMF-assisted closure and 9 patients (33%) underwent FF-assisted closure. Patients within the FF group scored consistently higher MDADI scores across all subscales (emotional, functional, physical, global) as well as composite MDADI score in comparison to the PC and PMMF groups. FF closure was associated with a reduced inpatient length of stay (LOS). Additionally, no significant differences in postoperative morbidity including rates of pharyngo-cutaneous fistula (PCF) were observed between groups.ConclusionsWe now advocate FF closure for our patients following salvage TL due to the improved dysphagia-specific QOL, reduced inpatient LOS and lack of additional surgical morbidity.Level of evidence, Level III, therapeutic/prognostic study.

Systematic Review of The Outcome of Different Modalities of Voice Rehabilitation Following Total Laryngectomy

Abstract Background Speech impairment occurs in 34-70% of head and neck oncologic patients. Management of this impairment is through surgical and nonsurgical methods. Progress in voice rehabilitation following total laryngectomy has over the last 30 years, made an enormous difference in the whole concept of the management of laryngeal cancers. Objective To explore the outcome of different options of voice rehabilitation after total laryngectomy and the advantages and disadvantages of each method in order to improve the quality of life of laryngectomized patients and the suggestion of future directions for research. Patients and Methods The Aim of this work is to provide cumulative data about the efficacy and safety of the outcome of different modalities of voice rehabilitation following total laryngectomy. This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) statement guidelines. Results Voice rehabilitation is one of the most important determinants of the quality of life after total laryngectomy. Recent advances in prosthetic voice devices have made such devices the gold standard for voice rehabilitation. They are thus preferred and used more often than old methods (esophageal speech and artificial larynx). Conclusion Although, no single method is considered to be the best for every patient, the tracheoesophageal puncture has become the most preferred method in the past decade. But it is not always possible in all patients, the results of this study indicate that ES, when achievable, is a viable option that should be considered by surgeons when making intervention decisions on patients, and should be revived when indicated. But we need much more studies.

Reduction in healthcare services during the COVID-19 pandemic: Patient screening based on symptoms is an effective strategy for avoiding delayed laryngeal cancer diagnosis

ObjectiveRestriction in healthcare services during the COVID-19 pandemic caused delays in the diagnosis and treatment of several diseases. To overcome the risk of missed diagnosis of head and neck cancers, before deleting the scheduled appointments, we have introduced a selection of the patients by examining the clinical presenting issue and previous medical history. The aim of this study is to show the effects of the abovementioned strategy on the diagnosis and management of laryngeal cancer. MethodsData were extracted from the Hospital software regarding the new diagnosis of laryngeal SCC in the periods from March 2020 to December 2020 during the pandemic (study group) and from March 2019 to December 2019 (control group) were collected. Data were compared regarding: TNM stage, time from first medical examination to histological diagnosis (Time-1), and time form histological diagnosis to beginning of treatments (Time-2). ResultsThe final study group was composed by 19 laryngeal cancers, the control group by 25 cases. No significant differences were found in the tumour stage between the groups. In the study group, Time-1 was shorter (24 days versus 43 days, p = 0.012), while Time-2 in surgically-treated patients was longer (20 days versus 9 days, p = 0.012). ConclusionDuring the pandemic, there was a dramatic lack of medical and nurse staff needed for surgical procedures. As consequence, the time between the diagnosis of malignancy and surgical treatment increased. In our unit, an efficient patient selection strategy to reschedule medical appointments avoided a dangerous shift toward higher laryngeal cancer stages.

Modular Approach to Open Partial Horizontal Laryngectomy: Step-by-Step Anatomic Dissection.

Open partial laryngectomies still play an important role in contemporary conservative management of laryngeal cancer. A comprehensive and systematic classification of open partial horizontal laryngectomies (OPHLs) was presented by the European Laryngological Society working committee in 2014. The aim of this video is to show the main surgical steps in OPHL using a cadaveric dissection and to explain the modular approach for removal of laryngeal tumors.

Laryngeal cancer

Laryngeal cancer is a common head and neck cancer and typically presents with voice hoarseness in patients older than 60 years. Early recognition of signs and symptoms of laryngeal cancer can lead to early diagnosis and treatment, therefore improving patient outcomes. This article aims to provide an overview of the anatomy of the larynx, presentation and management of laryngeal cancer, and common follow-up problems.

A roadmap of six different pathways to improve survival in laryngeal cancer patients.

Laryngeal cancer continues to require improvement in earlier stage diagnosis and better imaging delineation of disease, and hence 'more evidence-based' selection of treatment, as recent evidence suggests that related mortality, in the last decades, has not significantly decreased worldwide. Even though the reasons are not fully understood, there persists an urgency for a review and development of future strategies to embrace such clinical and diagnostic challenges from a political, societal, as well as scientific and clinical points of view. This review of the published literature suggests that survival improvement in laryngeal cancer may be achieved by fuelling and combining at least some or all of six targeted agendas: documentation of disease global incidence and national burden monitoring; development and implementation of high-quality cancer registries; education on risk factors and hazardous habits associated with laryngeal cancer for the general population; active modification of proven at-risk population lifestyles; centralization of treatment; and use of machine learning of gathered 'big data' and their integration into approaches for the optimization of prevention and treatments strategies. Laryngeal cancer should be tackled on several fronts, commencing with disease monitoring and prevention, up to treatment optimisation. Available modern resources offer the possibility to generate significant advances in laryngeal cancer management. However, each nation needs to develop a comprehensive approach, which is an essential prerequisite to obtain meaningful improvement on results.

Emerging Concepts and Novel Strategies in Radiation Therapy for Laryngeal Cancer Management.

Laryngeal squamous cell carcinoma is the second most common head and neck cancer. Its pathogenesis is strongly associated with smoking. The management of this disease is challenging and mandates multidisciplinary care. Currently, accepted treatment modalities include surgery, radiation therapy, and chemotherapy—all focused on improving survival while preserving organ function. Despite changes in smoking patterns resulting in a declining incidence of laryngeal cancer, the overall outcomes for this disease have not improved in the recent past, likely due to changes in treatment patterns and treatment-related toxicities. Here, we review emerging concepts and novel strategies in the use of radiation therapy in the management of laryngeal squamous cell carcinoma that could improve the relationship between tumor control and normal tissue damage (therapeutic ratio).

Indian clinical practice consensus guidelines for the management of laryngeal cancer

Indian clinical practice consensus guidelines for the management of laryngeal cancer

Outcomes Following Transoral Laser Microsurgery With Resection of Cartilage for Laryngeal Cancer.

The ability to treat more advanced laryngeal cancers by transoral approaches has expanded significantly in the past several decades. Transoral management of laryngeal cancers that require removal of the laryngeal framework is controversial. Resecting cartilage through endoscopic means carries inherent technical challenges and the question of oncologic safety. We describe a retrospective review of patients undergoing resection of the thyroid cartilage during transoral laser microsurgery (TLM) for laryngeal cancer over a 10-year period. Only patients with 5-year follow-up were included. Fourteen patients were identified that underwent attempted endoscopic resection of the thyroid cartilage. Preoperative staging ranged from T1 to T4 laryngeal cancers. Most patients underwent resection of the thyroid cartilage either for close proximity of the tumor to cartilage or microscopic involvement of the inner perichondrium, although 6 patients had gross invasion of the cartilage. Twelve patients underwent successful endoscopic clearance. Two patients were converted to total laryngectomy either at the time of surgery or shortly after due to extent of disease that was deemed not amenable to endoscopic resection. Overall 5-year survival was 71%. Disease-free survival was 62% at 5 years. The majority of patients avoided gastrostomy and tracheostomy tube dependence. One patient underwent total laryngectomy following initial TLM for chronic aspiration. We conclude that TLM for laryngeal cancer performed with removal of thyroid cartilage is feasible. Both oncologic and functional outcomes are reasonable in a select group of patients. This paper describes that cartilage can be resected endoscopically in the appropriate setting and not necessarily that cartilage invasion should routinely be treated with TLM.

Rapid histology of laryngeal squamous cell carcinoma with deep-learning based stimulated Raman scattering microscopy.

Maximal resection of tumor while preserving the adjacent healthy tissue is particularly important for larynx surgery, hence precise and rapid intraoperative histology of laryngeal tissue is crucial for providing optimal surgical outcomes. We hypothesized that deep-learning based stimulated Raman scattering (SRS) microscopy could provide automated and accurate diagnosis of laryngeal squamous cell carcinoma on fresh, unprocessed surgical specimens without fixation, sectioning or staining.Methods: We first compared 80 pairs of adjacent frozen sections imaged with SRS and standard hematoxylin and eosin histology to evaluate their concordance. We then applied SRS imaging on fresh surgical tissues from 45 patients to reveal key diagnostic features, based on which we have constructed a deep learning based model to generate automated histologic results. 18,750 SRS fields of views were used to train and cross-validate our 34-layered residual convolutional neural network, which was used to classify 33 untrained fresh larynx surgical samples into normal and neoplasia. Furthermore, we simulated intraoperative evaluation of resection margins on totally removed larynxes.Results: We demonstrated near-perfect diagnostic concordance (Cohen's kappa, κ > 0.90) between SRS and standard histology as evaluated by three pathologists. And deep-learning based SRS correctly classified 33 independent surgical specimens with 100% accuracy. We also demonstrated that our method could identify tissue neoplasia at the simulated resection margins that appear grossly normal with naked eyes.Conclusion: Our results indicated that SRS histology integrated with deep learning algorithm provides potential for delivering rapid intraoperative diagnosis that could aid the surgical management of laryngeal cancer.

The Treatment of Laryngeal Cancer.

Successful management of laryngeal cancer depends on careful pretreatment evaluation of patient and disease factors to arrive at accurate staging, leading to appropriate treatment selection for patients with this highly impacting disease. Surgical modalities, including transoral laser microsurgery, open partial laryngectomy, and total laryngectomy, offer options, alone or in combination with radiation and chemotherapy. Treatment strategy for laryngeal cancer should strive for cure while maintaining the best quality of life possible for the patient. Achieving the goals of initial and salvage treatment for laryngeal cancer depends on executing a plan of care determined by the expertise of the multidisciplinary team.

Organ preservation for advanced larynx cancer: A review of chemotherapy and radiation combination strategies

The larynx is an organ of the upper aerodigestive tract that is involved in many critical functions such as breathing, speaking, and swallowing. As a result, both larynx cancer and its treatment may significantly affect quality of life. The management of laryngeal cancer has focused on improving survival while preserving the function of the organ. This manuscript focuses on the use of chemotherapy and radiation therapy as a non-surgical approach and potential organ preservation strategy for patients with advanced larynx cancer. We review the key clinical data on the following treatment courses: (1) induction chemotherapy followed by definitive radiation therapy, (2) concurrent chemotherapy and radiation, and (3) induction chemotherapy followed by concurrent chemo-radiation. We also review the clinical data on organ preservation for patients with hypopharynx cancers. Results from phase III studies suggest that patients with advanced T4 cancers have better outcomes with a primary surgical approach, while for patients with T2N+ and T3 tumors, definitive concurrent chemotherapy and radiation or induction chemotherapy followed by definitive radiation therapy are acceptable options. Choosing the optimal treatment strategy depends on patients’ desires, tumor extent, and adequate follow-up to detect early recurrences in cases of larynx preservation treatments. To proceed with an organ preservation strategy, the patient should have a good pre-treatment larynx function, and there must be a high level of skill and cooperation among various disciplines.

Effects of Different Treatment Strategies and Tumor Stage on Survival of Patients with Advanced Laryngeal Carcinoma: A 15-Year Cohort Study.

Background Laryngeal cancer is the second most common cancer in the head and neck. Since laryngeal cancer management is a complex process, there is still no standard strategy to treat this disease in order to increase the survival rate of the patients especially among those with advanced form of the disease. Methods A cohort study was undertaken to analyze factors predicting survival of the patients in advanced stage laryngeal cancer in the Southern Iran among all patients newly diagnosed with laryngeal cancer between 2000 and 2015. Results Data of a total number of 415 patients who have had been diagnosed with advanced laryngeal cancer during this period was used for analysis. The patients' 1-, 3-, 5-, and 10-year survival rates were 81%, 62%, 53%, and 38%, respectively. Multivariable Cox regression analyses indicated a significant relationship between patients' survival and age at diagnosis (P < 0.001), disease stage (P = 0.002), tumor grade (P = 0.008), positive L. node (P = 0.008), and type of treatment (P < 0.001). As expected, treatment strategy was identified as the most effective factor in survival of the patients. According to the results, patients who undergone surgical treatment experienced a longer survival than those who received other treatments. Conclusion This study showed that the survival of patients depends on several factors, among which, treatment strategy is the most important. Combination of total laryngectomy plus chemoradiation provides superior local control and better survival compared to either radiotherapy or chemoradiation in patients with advanced laryngeal cancer.

Abstract 20: Individualized outcome prognostication for patients with larynx cancer

Abstract Background: Accurate and individualized prognostication is obligatory to the optimal management of larynx cancer. The wide variety of treatment options has made decision making complex and challenging for patients and physicians. Predictive models have been developed to calculate the risk of oncologic outcomes using individualized patient data. Implementing these predictive models into clinical practice may improve patient counseling and clinical management, but preemptive validation of their accuracy and reliability is essential. Aim: To utilize an independent patient cohort to characterize and externally validate existing prognostic calculators for larynx cancer. Methods: Four published prognostic calculators that use individualized information to predict 5-year overall survival for patients with larynx cancer were utilized. Analyses were performed using an independent cohort of 246 patients with previously untreated larynx cancer diagnosed between 2002 and 2012. Clinical and oncologic factors were extracted from a prospective epidemiology database and confirmed via chart abstraction. Survival estimates were calculated using each of the four models and subsequent analyses compared the calculators to one another and in reference to observed outcomes. Median follow-up was 48 months. Results: The observed mean 5-year overall survival within the entire cohort was 72%, whereas each of the calculators predicted significantly worse outcomes, with a mean 5-year overall survival of 47%. One model predicted notably lower survival estimates compared to the others, particularly when assigning outcomes to patients with higher risk disease; otherwise, correlation coefficients were fair (0.62-0.81). Analyses of discrimination suggested that two calculators underperform in their capacity to stratify low- and high-risk patients, whereas two others underperform in their discrimination of mid-stage risk. The AUC ranged from 0.65 to 0.73. C-index values were similar for each of the four models (0.66 to 0.69). Multivariate modeling for calculator-estimated survival estimates identified surgical intervention and induction chemotherapy as predictive of better-than-expected outcomes. Conclusion: Prognostic calculators varied in their ability to accurately predict survival in an external cohort of patients with larynx cancer. Suboptimal reliability and accuracy limit the potential integration of existing individualized prediction tools into routine clinical decision-making. The calculators significantly underestimated survival among patients treated with induction chemotherapy and primary surgery, suggesting that treatment modality may need to be better integrated into revised prediction tools. Deficiencies in calculator performance may be further explained by institutional variation in oncologic outcomes. Citation Format: Connor W. Hoban, Emily L. Belille, Lauren Beesley, Gregory T. Wolf, Jeremy M.G. Taylor, Andrew G. Shuman. Individualized outcome prognostication for patients with larynx cancer [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 20.

Individualized outcome prognostication for patients with laryngeal cancer.

Accurate prognostication is essential to the optimal management of laryngeal cancer. Predictive models have been developed to calculate the risk of oncologic outcomes, but extensive external validation of accuracy and reliability is necessary before implementing them into clinical practice. Four published prognostic calculators that predict 5-year overall survival for patients with laryngeal cancer were evaluated using patient information from a prospective epidemiology study cohort (n = 246; median follow-up, 60 months) with previously untreated, stage I through IVb laryngeal squamous cell carcinoma. Different calculators yielded substantially different predictions for individual patients. The observed 5-year overall survival was significantly higher than the averaged predicted 5-year overall survival of the 4 calculators (71.9%; 95% confidence interval [CI], 65%-78%] vs 47.7%). Statistical analyses demonstrated the calculators' limited capacity to discriminate outcomes for risk-stratified patients. The area under the receiver operating characteristic curve ranged from 0.68 to 0.72. C-index values were similar for each of the 4 models (range, 0.66-0.68). There was a lower than expected hazard of death for patients who received induction (bioselective) chemotherapy (hazard ratio, 0.46; 95% CI, 0.24-0.88; P = .024) or primary surgical intervention (hazard ratio, 0.43; 95 % CI, 0.21-0.90; P = .024) compared with those who received concurrent chemoradiation. Suboptimal reliability and accuracy limit the integration of existing individualized prediction tools into routine clinical decision making. The calculators predicted significantly worse than observed survival among patients who received induction chemotherapy and primary surgery, suggesting a need for updated consideration of modern treatment modalities. Further development of individualized prognostic calculators may improve risk prediction, treatment planning, and counseling for patients with laryngeal cancer. Cancer 2018;124:706-16. © 2017 American Cancer Society.

Transoral laser surgery for laryngeal carcinoma: has Steiner achieved a genuine paradigm shift in oncological surgery?

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predominantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase 'paradigm shift' in his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and colleagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the management of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples' dogma makes his contribution truly a genuine paradigm shift.