Cancer spread in the larynx: A pathologic basis for conservation surgery

Background. Previous pathologic studies of the spread of laryngeal carcinom a have drawn inferences about the site of origin of tumors, their mechanism s of growth, or the role of structures as potential barriers to tumor sprea d. Most of the information is based on the study of advanced or recurrent t umors and is difficult to apply to conservation surgical technique. We carr ied out a systematic analysis of a wide range of laryngeal tumors with the aim of providing a basis for conservation surgery. Methods. We analyzed tumor invasion of the laryngeal spaces and the larynge al framework in relation to the mucosal tumor extent by axial sectioning of 80 sequential partial and total laryngectomy specimens. Results. Invasion of a particular laryngeal space could be accurately predi cted by mucosal tumor extent and Vocal cord mobility. Invasion of the laryn geal framework was associated with tumor extension to the ventricle, subglo ttis, or pyriform fossa. The thyroid cartilage and the cricothyroid space a nd ligament were the most frequent sites of invasion. Conclusions. The mucosal distribution of a tumor and observation of vocal c ord mobility can be used to determine accurately the extent of tumor invasi on of the laryngeal spaces and framework and therefore the extent of resect ion necessary. (C) 2000 John Wiley & Sons, Inc.