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Background: The aim of this retrospective study was to identify different radiological features in intermediate⁻advanced laryngeal cancer (LC) associated with arytenoid fixation, in order to differentiate cases still safely amenable to conservative treatment by partial laryngectomy or chemoradiotherapy. Methods: 29 consecutive patients who underwent open partial horizontal laryngectomies (OPHLs), induction chemotherapy followed by radiotherapy in the case of >50% response (IC + RT) or total laryngectomy were classified as: pattern I (supraglottic LC fixing the arytenoid due to weight effect), pattern II (glottic LC involving the posterior paraglottic space and spreading toward the crico-arytenoid joint and infraglottic extension <10 mm), pattern III (glottic-infraglottic LC involving the crico-arytenoid joint and infraglottic extension >10 mm) and pattern IV (transglottic and infraglottic LC with massive crico-arytenoid unit involvement, reaching the hypopharyngeal submucosa). All glottic cancers treated with surgery were studied by a cross sectional approach. Results: A substantial agreement between the work-up and the pathology results has been obtained in each of the subcategories. Three-year disease-free survivals, local control and freedom from laryngectomy were significantly better in pattern II compared to pattern III⁻IV. Conclusions: LC showing fixed arytenoid due to weight effect or posterior paraglottic space involvement with infraglottic extension <10 mm assessed at the true vocal cord midline are still safely manageable by OPHL or IC + RT.

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BACKGROUND: The purpose of this retrospective study was to identify subcategories in cT3 to cT4a supraglottic/glottic cancers, describing their different spreading patterns, and local and locoregional recurrence modes. METHODS: Four hundred eighty-nine patients who underwent open partial horizontal laryngectomies (OPHLs) were retrospectively classified as: subcategory I (anterior pT3 with normal arytenoid mobility); subcategory II (posterior pT3 with impaired/absent mobility); subcategory III (anterior pT4 with normal mobility); and subcategory IV (posterior pT4 with impaired/absent mobility). RESULTS: Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional, local control, freedom from laryngectomy, and laryngectomy-free survival were significantly better in anterior tumors (subcategories I and III) when compared with the corresponding posterior ones (subcategories II and IV). CONCLUSION: Anterior cT3 tumors are manageable by OPHL, and this approach could also be proposed in the treatment of early anterior cT4aN0. Despite promising results, OPHLs should be considered under investigation in posterior cT3 tumors due to clinical and biological behavior similar to cT4a tumors.

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The first supratracheal partial laryngectomy (STPL) with tracheohyoidoepiglottopexy was performed in 1972. This procedure entailed preservation of the suprahyoid epiglottis as well as a pexy of the hyoid bone and residual epiglottis to the first tracheal ring; however, this technique was abandoned by the same author in the early 1980s because of poor functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck 39: 392-398, 2017.

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BACKGROUND: Cancer of the larynx in the intermediate/advanced stage still presents a major challenge in terms of controlling the disease and preserving the organ. Among therapeutic options, open partial horizontal laryngectomy is proposed as a function-sparing surgical technique. METHODS: We analyzed the clinical outcomes of 555 patients with laryngeal cancer staged pT3 to pT4a who underwent open partial horizontal laryngectomy. RESULTS: Five-year overall survival (OS), disease-free survival (DFS), locoregional control, local control, laryngectomy-free survival, and laryngeal function preservation rates were 84.6%, 84.2%, 86.3%, 90.6%, 93.3%, and 91.2%, respectively. DFS, locoregional control, and laryngeal function preservation rates were significantly affected by pT4a staging (68.1%, 71.7%, and 78.0%, respectively), whereas pN+ influenced only DFS (≤72.6%) and locoregional control (≤79.6%). CONCLUSIONS: Open partial horizontal laryngectomy with a modular approach can be considered effective in terms of prognostic and functional results in intermediate-stage and selected advanced-stage laryngeal cancers, even with subglottic extension. © 2015 Wiley Periodicals, Inc. Head Neck 38: E649-E657, 2016.

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BACKGROUND: Laryngeal squamous cell carcinoma (SCC) accounts for 1.9% of cancers worldwide. Most of these are diagnosed in the early stages (T1-T2, and N0). For these, a larynx preserving/conserving option is preferable. Beyond transoral laser microsurgery (TLM), open partial horizontal laryngectomy is a function-sparing surgical technique used to treat laryngeal SCC. METHODS: We retrospectively analyzed the clinical outcomes of 216 patients who underwent open partial horizontal laryngectomy for glottic cT2 laryngeal cancer. RESULTS: Five-year overall survival (OS), disease-specific survival (DFS), locoregional control, local control, laryngeal function preservation, and laryngectomy-free survival rates were 93.1%, 98.0%, 97.1%, 97.5%, 97.8%, and 98.5%, respectively. Disease controls were significantly affected by previous treatment and type of surgery used. CONCLUSION: Although TLM for cT2 laryngeal cancer with unimpaired vocal cord mobility still represents a sound option, open partial horizontal laryngectomy offers higher local control and laryngeal preservation rates for selected patients with impaired mobility of vocal cords combined with involvement of the paraglottic space. © 2015 Wiley Periodicals, Inc. Head Neck 38: E333-E340, 2016.

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BACKGROUND: Laryngeal cancer management should pursue function-sparing therapeutic options. Even though demolitive surgery provides better control of disease at intermediate to advanced stages when compared to chemoradiotherapy, it does not preserve laryngeal function. Supratracheal partial laryngectomy has been described as a function-sparing surgical technique for laryngeal cancer with subglottic extension. METHODS: In this retrospective study, we analyzed the clinical outcomes of 115 patients who underwent supratracheal partial laryngectomy. RESULTS: At 5 years, overall survival (OS), disease-free survival (DFS), and locoregional control rates were 78.9%, 68.5%, and 69.6%, respectively; DFS and locoregional control prevalences were greatly affected by pT4a classification (49.0% and 51.4%, respectively); and laryngeal function preservation was maintained in 78.3% of patients despite being affected by pT4a classification (59.3%) and age ≥65 (64.6%). CONCLUSION: For cases with glottic tumors and with subglottic extension, the choice of supratracheal partial laryngectomy versus chemoradiotherapy can be considered to be effective in terms of prognostic and functional results.

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After open partial laryngectomy (HOPL), many patients experience deterioration of laryngeal function over time. The aim of this study was to evaluate laryngeal functional outcome at least 10 years after surgery in a cohort of 80 elderly patients. The incidence of aspiration pneumonia (AP) and objective/subjective laryngeal functional assessments were carried out. Eight patients experienced AP including four with repeated episodes. A significant association was observed between AP and severity of dysphagia (p < 0.001). Dysphagia was more pronounced than in a normal population of similar age, but less than would be expected. There was a significant association between the type of intervention and grade of dysphagia/dysphonia; a difference in voice handicap was found, depending on the extent of glottic resection. After HOPL, laryngeal function was impaired, but this did not significantly affect the quality of life. AP is more frequent in the initial post-operative period, and decreases in subsequent years.

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