Indications for frontolateral laryngectomy and prognostic factors of failure

The aim of this study was a retrospective analysis of the oncological resul ts in a group of patients treated by frontolateral laryngectomy using clini cal and histopathological correlations in order to review the indications f or surgery. In all, 150 patients underwent frontolateral laryngectomy as de scribed by Leroux-Robert. All were staged according to the 1992 UICC TNM cl assification. Factors examined were clinical T, histopathological T, tumor infiltration of the anterior commissure and the vocal cord muscle, survival without disease and the percentage of local relapses. Twenty-one patients had local relapses (14%), while four patients developed second primary tumo rs (2.7%). Among the different correlations examined, microscopic infiltrat ion of the anterior commissure was related to a greater number of local rel apses (25.5% vs 5%) and a 55% survival with with no evidence of disease (NE D). The crude 5-year NED survival was 66% and was influenced by second prim ary tumors and metastases (7.4%) and non-oncological diseases (14.6%). Thes e data show the need for a re-evaluation of the indications for frontolater al laryngectomy because subtotal reconstructive laryngectomy could be perfo rmed more safely in the more advanced cases. In contrast, cases with more l imited tumors might be better treated by laser for a more functional and co st-beneficial result.