The role of partial laryngeal resection in current management of laryngealcancer: a collective review

A spectrum of treatment plans and surgical procedures is available for mana gement of early and moderately advanced laryngeal cancer. While the approac h of chemotherapy and irradiation, or irradiation alone, followed by total laryngectomy. for failure is often employed in practice by present day clin icians, the options of conventional conservation surgery (CCS), transoral e ndoscopic laser surgery (TLS) and supracricoid partial laryngectomy (SCPL) provide a wide choice of treatments that may help attain the goal of cure w ith preservation of laryngeal function and integrity of the airway. While C CS has been supplanted for many early-stage lesions by TLS and for more adv anced stages by SCPL, centres throughout the world have reported favourable results with CCS, which is often modified to include resection of more ext ensive tumours than was previously possible. During the past decade a numbe r of extended CCS procedures have been developed for management of glottic rumours involving both vocal cords and the anterior commissure, the paraglo ttic space and with vocal cord fixation, and for supraglottic rumours invol ving the glottis or hypopharynx. TLS has proved an effective, minimally inv asive and functionally satisfactory procedure For management of suitable T1 and T2 glottic cancers, and stage I-III supraglottic cancers. The procedur e may be effectively employed in combination with neck dissection and posto perative radiotherapy when necessary, particularly for moderately advanced supraglottic carcinomas. SCPL has proven effective in management of glottic and supraglottic cancers of all stages, even with involvement of paraglott ic space and thyroid cartilage, provided at least one arytenoid unit can be preserved with clear margins. Invasion of cricoid cartilage is the most si gnificant limitation for this procedure. All three surgical approaches have been employed for irradiation failure, but with greatly increased Failure and complication rates compared with the results of treatment of non-irradi ated patients. Thus a decision to treat laryngeal cancer initially with irr adiation may preclude a satisfactory result from partial laryngectomy shoul d radiation fail. The treatment of laryngeal cancer should be individualize d according to the size and extent of the tumour, the age and physical cond ition of the patient, and the skill and experience of the surgeon with vari ous treatment modalities and surgical procedures.