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

Conservation Laryngeal Surgery, Vertical Partial Laryngectomy: Workup

Author: Jon Robitschek, MD, Resident Physician, Department of Otolaryngology, Tripler Army Medical Center
Coauthor(s): Jessica J Peck, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center; Christopher Klem, MD, Consulting Staff, Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center; Christopher H Rassekh, MD, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, West Virginia University
Contributor Information and Disclosures

Updated: Jan 14, 2009

Workup

Laboratory Studies

Laboratory studies are not generally required for VPL except as indicated to evaluate any comorbid conditions. Some physicians perform a metastatic screen to look for evidence of tumor spread to lung, liver, or bone, but the yield of these tests on small tumors amenable to VPL is low.

Imaging Studies

  • Imaging studies are not usually required except to assess patients for comorbid conditions or synchronous primary cancers. In such cases, a chest radiograph (CXR) is indicated.
  • Barium swallow should be considered in symptomatic patients.
  • A neck CT scan should be considered to evaluate thyroid cartilage invasion in patients with anterior commissure involvement.
  • A CT scan of the head and neck with fine cuts (1 mm) through the larynx should be considered in patients with vocal cord impairment or fixation.

Other Tests

Other tests are needed to assess operative risk as indicated for comorbid conditions.

Diagnostic Procedures

  • Diagnostic tests include flexible laryngoscopy in the office to assess vocal cord and arytenoid mobility and the extent of the lesion.
  • A thorough head and neck examination should be performed.
  • Panendoscopy to exclude synchronous malignancy in the head and neck, tracheobronchial tree, and esophagus is controversial, but should be performed in most cases.
  • Preoperative and postoperative videostroboscopy and voice recording for functional assessment and documentation are important parts of patient evaluation and care.

Histologic Findings

The histology of initial tumors usually reveals squamous cell carcinoma arising from dysplasia. Minor salivary carcinomas, most commonly adenoid cystic carcinoma, are rare. Small cell carcinoma, other neuroendocrine tumors, and sarcoma are extremely rare. Granular cell tumors, plasmacytoma, and other lesions that resemble malignancy should also be considered in the differential diagnoses. Recurrences following radiotherapy are histologically characterized by small nests of neoplastic cells lying deep below intact mucosa. Most recurrent carcinomas present with multicentric tumor foci, whereas most primary carcinomas present with a central tumor location.  Marked perineural infiltration has lead to the hypothesis that recurrent tumors grow alongnerves involving previously unaffectedareas.1

More on Conservation Laryngeal Surgery, Vertical Partial Laryngectomy

Overview: Conservation Laryngeal Surgery, Vertical Partial Laryngectomy
Workup: Conservation Laryngeal Surgery, Vertical Partial Laryngectomy
Treatment: Conservation Laryngeal Surgery, Vertical Partial Laryngectomy
Follow-up: Conservation Laryngeal Surgery, Vertical Partial Laryngectomy
Multimedia: Conservation Laryngeal Surgery, Vertical Partial Laryngectomy
References
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References

  1. Zbaren P, Christe A, Caversaccio MD, et al. Pretherapeutic staging of recurrent laryngeal carcinoma: clinical findings and imaging studies compared with histopathology. Otolaryngol Head Neck Surg. Sep 2007;137(3):487-91. [Medline].

  2. Yiotakis J, Stavroulaki P, Nikolopoulos T, et al. Partial laryngectomy after irradiation failure. Otolaryngol Head Neck Surg. Feb 2003;128(2):200-9. [Medline].

  3. Brumund KT, Gutierrez-Fonseca R, Garcia D, et al. Frontolateral vertical partial laryngectomy without tracheotomy for invasive squamous cell carcinoma of the true vocal cord: a 25-year experience. Ann Otol Rhinol Laryngol. Apr 2005;114(4):314-22. [Medline].

  4. Bailey BJ. Head and Neck Surgery-Otolaryngology Atlas. Baltimore, Md:. Lippincott Williams & Wilkins;1996.

  5. Bailey BJ, Calcaterra TC. Vertical, subtotal laryngectomy and laryngoplasty. Review of experience. Arch Otolaryngol. Mar 1971;93(3):232-7. [Medline].

  6. Brasnu D, Laccourreye O, Weinstein G, et al. False vocal cord reconstruction of the glottis following vertical partial laryngectomy: a preliminary analysis. Laryngoscope. Jun 1992;102(6):717-9. [Medline].

  7. Davis RK, Hadley K, Smith ME. Endoscopic vertical partial laryngectomy. Laryngoscope. Feb 2004;114(2):236-40. [Medline].

  8. Kadish SP. Can I treat this small larynx lesion with radiation alone? Update on the radiation management of early (T1 and T2) glottic cancer. Otolaryngol Clin North Am. Feb 2005;38(1):1-9, vii. [Medline].

  9. Kambic V, Radsel Z, Smid L. Laryngeal reconstruction with epiglottis after vertical hemilaryngectomy. J Laryngol Otol. May 1976;90(5):467-73. [Medline].

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

  11. Pleet L, Ward PH, DeJager HJ, et al. Partial laryngectomy with imbrication reconstruction. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol. Sep-Oct 1977;84(5):ORL882-9. [Medline].

  12. Vachin F, Hans S, Atlan D, et al. [Long term results of exclusive chemotherapy for glottic squamous cell carcinoma complete clinical responders after induction chemotherapy]. Ann Otolaryngol Chir Cervicofac. Jun 2004;121(3):140-7. [Medline].

  13. Yeager LB, Grillone GA. Organ preservation surgery for intermediate size (T2 and T3) laryngeal cancer. Otolaryngol Clin North Am. Feb 2005;38(1):11-20, vii. [Medline].

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Further Reading

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Keywords

laryngeal surgery, conservation laryngeal surgery, glottic carcinoma, organ preservation, neck cancer, organ preservation for glottic carcinoma, vertical partial laryngectomy, VPL, laryngofissure and cordectomy, partial laryngectomy with imbrication laryngoplasty, frontolateral partial laryngectomy, muscle flap laryngoplasty, epiglottic laryngoplasty, organ preservation surgery of the larynx, endoscopic cordectomy

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Contributor Information and Disclosures

Author

Jon Robitschek, MD, Resident Physician, Department of Otolaryngology, Tripler Army Medical Center
Jon Robitschek, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Coauthor(s)

Jessica J Peck, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center
Disclosure: Nothing to disclose.

Christopher Klem, MD, Consulting Staff, Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center
Christopher Klem, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, and American Society for Reconstructive Microsurgery
Disclosure: Nothing to disclose.

Christopher H Rassekh, MD, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, West Virginia University
Christopher H Rassekh, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Cancer Society, American Head and Neck Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, and West Virginia State Medical Association
Disclosure: Nothing to disclose.

Medical Editor

David J Terris, MD, FACS, Porubsky Professor and Chairman, Department of Otolaryngology, Medical College of Georgia
David J Terris, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, American Bronchoesophagological Association, American College of Surgeons, American Head and Neck Society, Federation of American Societies for Experimental Biology, International Association of Endocrine Surgeons, Phi Beta Kappa, Radiation Research Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Karen Hall Calhoun, MD, William E Davis Professor and Chair, Department of Otolaryngology-Head and Neck Surgery, University of Missouri
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association
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: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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