Near total laryngectomy: a single institutional experience
Keywords:Cancer larynx, Cancer hypopharynx, Complications in, NTL, Voice in
Background: Near total laryngectomy (NTL) aims to remove cancer of larynx and hypopharynx while maintaining a lung powered, prosthesis free voice. The oncological and functional outcomes of NTL have been encouraging but the surgical procedure is complex. In this study, we present our experience with NTL in order to encourage more ENT and head and neck surgeons to take up the procedure.
Methods: Twenty-eight patients, who had undergone NTL at State cancer institute, Guwahati are analysed retrospectively for survival, disease free status, functional outcomes and complications.
Results: There were two recurrences: one local recurrence which was salvaged by a completion total laryngectomy. The other patient had distant metastasis and died eventually. Overall survival (OS) was 96.43% and event free survival (EFS) was 92.86%. The patient who died had extra-nodal extension (ENE) on post op histology (p=0.274). Two patients failed to develop any speech had stenosis of the shunt. One of these was the only Salvage NTL case (p=0.057). Tracheostome stenosis, poor swallow and shunt stenosis were the common complications in our series. Most of them resolved with some intervention. Multiple complications were seen in the salvage NTL cases.
Conclusions: Careful case selection and well executed surgery leads to acceptable results following NTL. Special attention should be paid to the salvage cases as they are prone to develop complications and failure to attain speech. Patients with adverse post-op histopathological examination (HPE), like ENE should be kept under close follow up.
Nocini R. Updates on larynx cancer epidemiology. Chin J Cancer Res. 2020;32(1):18-25.
Bradley PJ, Eckel HE. Hypoharyngeal Cancer. Adv Otorhinolaryngol. Basel, Karger. 2019;83:1-14.
Forastiere AA.Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J of clinical oncol. 2018;36(11):1143-69.
NCCN guidelines version 3. 2021.
Pearson BW, Desanto LW. Operative techniques in otolaryngology-head and neck surgery. 1990;1(1):28-41.
Pradhan SA, D’Cruz AK, Pai PS, Mohiyuddin A. Near-total laryngectomy in advanced laryngeal and pyriform cancers. Laryngoscope 2002;112:375-80.
D’Cruz A, Sharma S, Pai PS. Current status of near-total laryngectomy: review. J Laryngol Otol. 2012;126:556-62.
Pearson BW, Woods RD 2nd, Hartman DE. Extended hemilaryngectomy for T3 glottic carcinoma with preservation of speech and swallowing. Laryngoscope. 1980;90:1950-61.
Pearson BW. Subtotal laryngectomy. Laryngoscope. 1981;91:1904-12.
Aslan I, Baserer N, Yazicioglu E, Biliciler N, Hafiz G, Tinaz M et al. The functional and oncologic effectiveness of near-total laryngectomy. Am J Otolaryngol. 2002;23:196-20.
Pearson BW, DeSanto LW, Olsen KD, Salassa JR. Results of near-total laryngectomy. Ann Otol Rhinol Laryngol 1998;107:820-5.
Pradhan SA, D’Cruz AK, Pai PS. Near-total laryngectomy. Asian J Surg. 2002;25:27-34.
Bernáldez R, García-Pallarés M, Morera E, Lassaletta L, Del Palacio A, Gavilán J. Oncologic and functional results of near total laryngectomy. Otolaryngol Head Neck Surg. 2003;128:700-5.
Shenoy AM, Plinkert PK, Nanjundappa N, Premalata S, Arunodhay GR. Functional utility and oncologic safety of neartotallaryngectomy with tracheopharyngeal speech shunt in a Third World oncologic center. Eur Arch Otorhinolaryngol. 1997;254:128-32.
Andrade RP, Kowalski LP, Vieira LJ, Santos CR. Survival and functional results of Pearson’s near-total laryngectomy for larynx and pyriform sinus carcinoma. Head Neck. 2000;22:12-6.
Maamoun SI, Amira G, Younis A. Near total laryngectomy: a versatile approach for voice restoration in advanced T3 and T4 laryngeal cancer: functional results and survival. J Egypt Natl Canc Inst. 2004;16:15-21.
Thakar A, Bahadur S, Toran KC, Mohanti BK, Julka PK. Analysis of oncological and functional failures following near total laryngectomy. J Laryngol Otol. 2009;123:327-32.
Cakli H, Ozudogru E, Cingi E, Kecik C, Gürbüz K. Near total laryngectomy: the problems influencing functions and their solutions. Eur Arch Otorhinolaryngol. 2005;262:99-102.
Kavabata NK, Silva Neto AL, Gonçalves AJ, Alcadipani FA, Menezes MB. A nine-year institutional experience with near total laryngectomy. Am J Surg. 2004;188:111-4.
Puri A, Patel MH, Kothari KC. Near total laryngectomy-complications, function and survival: A sixteen-year institutional experience. Ann Otol Rhinol Laryngol. 1998;107(10 Pt 1):820-5.
Gavilan J. Speech results and complications of near-total laryngectomy. Ann Otol Rhinol Laryngol. 1996;105:729-33.