Abstract
Objective: Chemoradiation trials over the past 2 decades have assumed that the primary surgical option for intermediate stage laryngeal cancer (T2-T3/N0-N1) was total laryngectomy. However, partial laryngeal surgery (PLS), including transoral laser microsurgery (TLM) and supracricoid partial laryngectomy (SCL), can provide sound oncologic and functional outcomes, often without adjuvant therapy.
Method: We retrospectively evaluated oncologic and functional outcomes in laryngeal squamous cell carcinoma (LSCC) patients who underwent TLM or SCL from 1998-2010. Overall survival (OS) and recurrence-free survival (RFS) were calculated. The Communication Scale (CS) and Functional Outcome Swallowing Scale (FOSS) were used to evaluate speech and swallowing, respectively.
Results: Eighty-one patients were analyzed with median follow-up of 31 months. Eighty-four percent were T2-T3/N0-N1. Two- and 5-year OS probabilities were 84.2% (95% CI: 73.0-91.0%) and 59.3% (95% CI: 41.4-73.3%), respectively. There was no difference between the TLM and SCL cohorts in OS (P = .781) or RFS (P = .456). Ninety-four percent of patients still had a larynx at median 31 months. Seventy-five percent of patients avoided adjuvant therapy, including 67% of TLM and 84% of SCL patients. CS and FOSS were 2-or-better in 95% and 88%, respectively, designating functional postoperative voice and swallowing. TLM patients were more likely to have a CS of 2-or-better postoperatively (P = .041).
Conclusion: PLS can provide good oncologic and functional outcomes for intermediate stage LSCC and is an alternative to chemoradiation or total laryngectomy in select patients.
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