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Near-Total Laryngectomy Workup

  • Author: Brian Kip Reilly, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
Updated: Mar 21, 2014

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

See the list below:

  • 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.


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.

Contributor Information and Disclosures

Brian Kip Reilly, MD Assistant Professor of Otolaryngology and Pediatrics, Department of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine

Brian Kip Reilly, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.


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 Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, Society for Ear, Nose and Throat Advances in Children, New York Head and Neck Society, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Association, The Triological Society, American Medical Association, 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

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Nader Sadeghi, MD, FRCSC Professor, Otolaryngology-Head and Neck Surgery, Director of Head and Neck Surgery, George Washington University School of Medicine and Health Sciences

Nader Sadeghi, MD, FRCSC is a member of the following medical societies: American Head and Neck Society, American Thyroid Association, American Academy of Otolaryngology-Head and Neck Surgery, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

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, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

  1. Pressman JJ. Submucosal compartmentalization of the larynx. Ann Otol Rhinol Laryngol. 1956. 65:766-1.

  2. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med. 1991 Jun 13. 324(24):1685-90. [Medline].

  3. Wenig BL, Stegnjajic A, Abramson AL. Glottic reconstruction following conservation laryngeal surgery. Laryngoscope. 1989 Sep. 99(9):983-5. [Medline].

  4. Maceri DR, Lampe HB, Makielski KH, Passamani PP, Krause CJ. Conservation laryngeal surgery. A critical analysis. Arch Otolaryngol. 1985 Jun. 111(6):361-5. [Medline].

  5. Suits GW, Cohen JI, Everts EC. Near-total laryngectomy. Patient selection and technical considerations. Arch Otolaryngol Head Neck Surg. 1996 May. 122(5):473-5. [Medline].

  6. DeSanto LW. Cancer of the supraglottic larynx: a review of 260 patients. Otolaryngol Head Neck Surg. 1985 Dec. 93(6):705-11. [Medline].

  7. Akbas Y, Demireller A. Oncologic and functional results of supracricoid partial laryngectomy with cricohyoidopexy. Otolaryngol Head Neck Surg. 2005 May. 132(5):783-7. [Medline].

  8. Ambrosch P, Kron M, Steiner W. Carbon dioxide laser microsurgery for early supraglottic carcinoma. Ann Otol Rhinol Laryngol. 1998 Aug. 107(8):680-8. [Medline].

  9. Andrade RP, Kowalski LP, Vieira LJ, Santos CR. Survival and functional results of Pearson's near-total laryngectomy for larynx and pyriform sinus carcinoma. Head Neck. 2000 Jan. 22(1):12-6. [Medline].

  10. Brasnu D, Laccourreye H, Dulmet E, Jaubert F. Mobility of the vocal cord and arytenoid in squamous cell carcinoma of the larynx and hypopharynx: an anatomical and clinical comparative study. Ear Nose Throat J. 1990 May. 69(5):324-30. [Medline].

  11. Chen AY, Schrag N, Hao Y, Flanders WD, Kepner J, Stewart A, et al. Changes in treatment of advanced laryngeal cancer 1985-2001. Otolaryngol Head Neck Surg. 2006 Dec. 135(6):831-7. [Medline].

  12. Chevalier D, Laccourreye O, Brasnu D, Laccourreye H, Piquet JJ. Cricohyoidoepiglottopexy for glottic carcinoma with fixation or impaired motion of the true vocal cord: 5-year oncologic results with 112 patients. Ann Otol Rhinol Laryngol. 1997 May. 106(5):364-9. [Medline].

  13. DeSanto LW, Pearson BW, Olsen KD. Utility of near-total laryngectomy for supraglottic, pharyngeal, base-of-tongue, and other cancers. Ann Otol Rhinol Laryngol. 1989 Jan. 98(1 Pt 1):2-7. [Medline].

  14. Dumich PS, Pearson BW, Weiland LH. Suitability of near-total laryngopharyngectomy in piriform carcinoma. Arch Otolaryngol. 1984 Oct. 110(10):664-9. [Medline].

  15. Genden EM, Ferlito A, Rinaldo A, Silver CE, Fagan JJ, Suárez C, et al. Recent changes in the treatment of patients with advanced laryngeal cancer. Head Neck. 2008 Jan. 30(1):103-10. [Medline].

  16. Herranz-González J, Gavilán J, Martínez-Vidal J, Gavilán C. Supraglottic laryngectomy: functional and oncologic results. Ann Otol Rhinol Laryngol. 1996 Jan. 105(1):18-22. [Medline].

  17. Iro H, Waldfahrer F, Altendorf-Hofmann A, Weidenbecher M, Sauer R, Steiner W. Transoral laser surgery of supraglottic cancer: follow-up of 141 patients. Arch Otolaryngol Head Neck Surg. 1998 Nov. 124(11):1245-50. [Medline].

  18. Jepsen MC, Gurushanthaiah D, Roy N, Smith ME, Gray SD, Davis RK. Voice, speech, and swallowing outcomes in laser-treated laryngeal cancer. Laryngoscope. 2003 Jun. 113(6):923-8. [Medline].

  19. Kirchner JA, Som ML. Clinical significance of fixed vocal cord. Laryngoscope. 1971 Jul. 81(7):1029-44. [Medline].

  20. Laccourreye H, Laccourreye O, Weinstein G, Menard M, Brasnu D. Supracricoid laryngectomy with cricohyoidoepiglottopexy: a partial laryngeal procedure for glottic carcinoma. Ann Otol Rhinol Laryngol. 1990 Jun. 99(6 Pt 1):421-6. [Medline].

  21. Laccourreye O, Weinstein G, Brasnu D, Trotoux J, Laccourreye H. Vertical partial laryngectomy: a critical analysis of local recurrence. Ann Otol Rhinol Laryngol. 1991 Jan. 100(1):68-71. [Medline].

  22. Lee NY, O'Meara W, Chan K, Della-Bianca C, Mechalakos JG, Zhung J, et al. Concurrent chemotherapy and intensity-modulated radiotherapy for locoregionally advanced laryngeal and hypopharyngeal cancers. Int J Radiat Oncol Biol Phys. 2007 Oct 1. 69(2):459-68. [Medline].

  23. Levine PA, Debo RF, Reibel JF. Pearson near-total laryngectomy: a reproducible speaking shunt. Head Neck. 1994 Jul-Aug. 16(4):323-5. [Medline].

  24. Lima RA, Freitas EQ, Kligerman J, Paiva FP, Dias FL, Barbosa MM, et al. Near-total laryngectomy for treatment of advanced laryngeal cancer. Am J Surg. 1997 Nov. 174(5):490-1. [Medline].

  25. Motta G, Esposito E, Testa D, Iovine R, Motta S. CO2 laser treatment of supraglottic cancer. Head Neck. 2004 May. 26(5):442-6. [Medline].

  26. Naudo P, Laccourreye O, Weinstein G, et al. Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy. Otolaryngol Head Neck Surg. 1998 Jan. 118(1):124-9. [Medline].

  27. Pearson BW, Salassa JR, Hinnir ML. Transoral Laser Micro Resection of Advanced Laryngeal Tumors. Cummings, CW, Flint PW, et al. Otolaryngology-Head and Neck Surgery. 4th ed. Philadelphia: Elsevier Mosby; 2005. 2326-2345.

  28. Pradhan SA, Pai PS, Neeli SI, et al. Transoral laser surgery for early glottic cancers. Arch Otolaryngol Head Neck Surg. 2003 Jun. 129(6):623-5. [Medline].

  29. Rademaker AW, Logemann JA, Pauloski BR, Bowman JB, Lazarus CL, Sisson GA, et al. Recovery of postoperative swallowing in patients undergoing partial laryngectomy. Head Neck. 1993 Jul-Aug. 15(4):325-34. [Medline].

  30. Robbins KT, Michaels L. Feasibility of subtotal laryngectomy based on whole-organ examination. Arch Otolaryngol. 1985 Jun. 111(6):356-60. [Medline].

  31. Steiner W, Ambrosch P. Endoscopic Laser Surgery of the Upper Aerodigestive Tract. New York, NY: Thieme, 2000.

  32. Tufano RP. Organ preservation surgery for laryngeal cancer. Otolaryngol Clin North Am. 2002 Oct. 35(5):1067-80. [Medline].

  33. Tufano RP, Weinstein GS, Laccourreye O. Conservation Laryngeal Surgery. Cummings, CW, Flint PW, et al. Otolaryngology-Head and Neck Surgery. 4th ed. Philadelphia: Elsevier Mosby; 2005. 2346-2380.

  34. Weinstein GS, Laccourreye O, Brasnu D, Yousem DM. The role of computed tomography and magnetic resonance imaging in planning for conservation laryngeal surgery. Neuroimaging Clin N Am. 1996 May. 6(2):497-504. [Medline].

  35. Yu L, Syms C 3rd, Dietz W. Laryngeal compartmentalization after radiation therapy in a canine model. Otolaryngol Head Neck Surg. 2001 Oct. 125(4):385-92. [Medline].

  36. Zhang B, Xu ZG, Tang PZ. Elective lateral neck dissection for laryngeal cancer in the clinically negative neck. J Surg Oncol. 2006 May 1. 93(6):464-7. [Medline].

Lateral radiograph of the neck showing the different structures of the larynx: a, vallecula; b, hyoid bone; c, epiglottis; d, pre-epiglottic space; e, ventricle (air-space between false and true cords); f, arytenoid; g, cricoid; and h, thyroid cartilage.
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