eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Conservation Laryngeal Surgery, Near-Total Laryngectomy: Workup

Author: Brian Reilly, MD, Staff Physician, Department of Otolaryngology, McGaw Medical Center of Northwestern University
Coauthor(s): Barry L Wenig, MD, MPH, FACS, Professor, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University; Chief, Division of Otolaryngology-Head and Neck Surgery, Evanston Northwestern Healthcare
Contributor Information and Disclosures

Updated: Jul 2, 2008

Workup

Laboratory Studies

Order routine laboratory studies, including a basic chemistry panel (BMP), liver function test (LFT), and a complete blood count (CBC) to get a health baseline and look for metastases.

Elevated alkaline phosphatase indicates possible metastases or concomitant liver disease.

Elevated calcium levels should prompt further work-up for metastases.

Imaging Studies

Obtain a CT scan of the chest to rule out pulmonary metastases or synchronous primary tumors.

Order a neck/laryngeal CT scan with contrast for evaluation of cervical metastases to determine the presence or absence of cartilage invasion.

Other Tests

Patients often have chronic obstructive pulmonary disease (COPD) because of their heavy history of smoking. Pulmonary function tests may be indicated for some patients to determine pulmonary reserve and can help predict if lungs have sufficient power for phonation via the vibratory myomucosal shut.  

Diagnostic Procedures

Endoscopy should be performed prior to any type of laryngectomy to rule out synchronous primary cancers and to evaluate the primary laryngeal lesion and its appropriateness for surgery.

Histologic Findings

  • Greater than 93% of laryngeal tumors have a squamous cell histopathology.
  • Verrucous carcinomas are present in 2-4% of cases.
  • Adenocarcinomas and sarcomas occur in approximately 1% of cases, respectively.
  • The use of intraoperative frozen sections determines how extensive the resection must be to ensure complete excision of the lesion.

Staging

Laryngeal cancers are staged both clinically and radiographically prior to surgery. CT scans of the larynx with fine cuts, CT scans of the neck with and without contrast, and CT scans of the chest are obtained to characterize local spread and metastatic disease. Staging is generally performed as part of the endoscopy of stage T3 and T4 lesions.

More on Conservation Laryngeal Surgery, Near-Total Laryngectomy

Overview: Conservation Laryngeal Surgery, Near-Total Laryngectomy
Workup: Conservation Laryngeal Surgery, Near-Total Laryngectomy
Treatment: Conservation Laryngeal Surgery, Near-Total Laryngectomy
Follow-up: Conservation Laryngeal Surgery, Near-Total Laryngectomy
References
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References

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Further Reading

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Keywords

conservation laryngeal surgery, laryngeal cancer, laryngeal organ preservation surgery, near-total laryngectomy, Pearson laryngectomy, cancer surgery, near total laryngectomy, sub-total laryngectomy, laryngectomy, NTL, laryngeal cancer, neck cancer, laryngeal carcinoma, glottic cancer, glottic carcinoma, supraglottic cancer, base of tongue cancer, hypopharyngeal cancer, tongue cancer, larynx cancer, glottic tumor, laryngeal tumor, tracheoesophageal puncture, TEP

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Contributor Information and Disclosures

Author

Brian Reilly, MD, Staff Physician, Department of Otolaryngology, McGaw Medical Center of Northwestern University
Brian Reilly, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Barry L Wenig, MD, MPH, FACS, Professor, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University; Chief, Division of Otolaryngology-Head and Neck Surgery, Evanston Northwestern Healthcare
Barry L Wenig, MD, MPH, FACS is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Association for Research in Otolaryngology, Chicago Medical Society, New York Academy of Medicine, New York Academy of Sciences, New York Head and Neck Society, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Medical Editor

M Abraham Kuriakose, MD, DDS, FRCS, Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences
M Abraham Kuriakose, MD, DDS, FRCS is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, British Association of Oral and Maxillofacial Surgeons, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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