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

Conservation Laryngeal Surgery, Vertical Partial Laryngectomy: Follow-up

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

Outcome and Prognosis

In previously untreated patients, reported local control rates as primary therapy are greater than 90% for T1 glottic tumors and 68% for T2 glottic tumors. Increased risk factors for recurrence include anterior commissure involvement, increased T stage, and positive surgical margins.3

In patients who undergo salvage therapy secondary to RT failure, the reported local control rates are 84% and 60% for T1 and T2 glottic tumors, respectively. The overall survival for this group of patients is reported at 77%.2

With regard to T3 glottic tumors, local control rates vary among different institutions, with reported failure rates as high as 50%.

Future and Controversies

Primary radiotherapy and transoral laser excision remain the prototypical therapy for early glottic tumors. Vertical partial laryngectomy (VPL) serves as both primary and salvage therapy for T1 and T2 disease with equivocal control rates for T3 tumors. Choosing the ideal surgical modality for tumors that bridge the T2/T3 classification system remains an intense area of controversy, without clear delineation in the literature. The intended goal of this article is to highlight the limits of VPL as much as its therapeutic efficacy.

Advances in transoral surgical approaches have contributed to the development and advances of endoscopic VPL. Future directions in research and technical innovation will likely focus on voice conservation, the role of chemotherapy, and stratification of patients based on tumor biology.

In particular, anterior commissure involvement, supracricoid partial laryngectomy, and the different reconstructions will continue to generate controversy and debate among head and neck surgeons. Patient desire and surgeon bias will continue to play dominant roles in the selection of treatment modality for early laryngeal carcinoma.

 


More on Conservation Laryngeal Surgery, Vertical Partial Laryngectomy

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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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