Retrospective comparison of swallowing function: Organ-Preserving approach in laryngeal carcinoma vs. total Laryngectomy

Introduction The decision between partial laryngectomy (pLE) and total laryngectomy (tLE) in locally advanced laryngeal carcinomas (LA-LC) depends on various factors, including the extent of the tumor. The advantage of pLE is postulated to be better speech capability compared to complete laryngectomy. However, there is a potential risk of aspiration. Over the past ten years, there has been a reevaluation of the resection of LA-LC, shifting from pLE to tLE. The aim is to compare functionality between the two methods in two groups with comparable tumor extents.

Material and methods Open pLEs and tLEs performed over a 13-year period were included. All reconstruction techniques were reconsidered. Assessment of functional outcomes was conducted four months after therapy completion. Transoral (open) tumor resections were excluded.

Results A total of 109 pLEs and 69 tLEs were performed. An R0 status was achieved in 104 pLEs and 66 tLEs (95% vs. 96%, p=0.611). A total of 51 T3 (31 pLEs, 20 tLEs) and 53 T4 tumors (12 pLEs, 41 tLEs) underwent surgery. Unproblematic oral nutrition was significantly better achieved after tLE compared to pLE (T3: 90% vs. 48%, p=0.002; T4: 92.6% vs. 16%, p=<0.001). The tracheostoma could not be closed in 71% of T3- and 92% of T4-pLEs. No significant differences were observed regarding the ability for phonation (T3: 66% vs. 70%, p=0.961; T4: 58% vs. 54%, p=0.669) or the 5-year survival rate (T3: 43% vs. 47%, p=0.702; T4: 40% vs. 24%, p=0.479).

Discussion With comparable 5-year survival rates and outcomes in voice rehabilitation, pLE- patients exhibit less advantageous outcomes in terms of swallowing and often retain the tracheostoma. These results support the paradigm shift in the surgery of advanced LA-LC, which involves a decrease in open pLE.

Publication History

Article published online:
19 April 2024