Principles of surgical treatment of laryngeal cancer

The principle of surgical treatment of laryngeal cancer is to reconstruct and restore the three major functions of the larynx, namely pronunciation, breathing and swallowing, as much as possible under the premise of completely removing the tumor, so as to achieve the goal of both curing the cancer and improving the patient's quality of life after surgery.

1. Partial laryngectomy is a general term for a group of surgeries, which involves removing a portion of the laryngeal tissue and preserving another portion of the laryngeal tissue, in order to preserve the laryngeal function as much as possible on the basis of complete removal of the tumor. Partial laryngectomy has become one of the main surgical methods for laryngeal cancer and is suitable for early-stage laryngeal cancer.

2. Total laryngectomy: Patients with subglottic cancer, late laryngeal cancer, and supraglottic cancer who are no longer suitable for partial laryngectomy are suitable for total laryngectomy. Although some local laryngeal cancer lesions can be treated with partial laryngectomy, total laryngectomy should also be performed if the overall condition is poor.

The scope of total laryngectomy is the upper trachea, sternothyroid muscle, thyrohyoid muscle, and sternohyoid muscle of the entire larynx. Whether the hyoid bone is removed depends on the condition. If the tumor has not destroyed the thyroid cartilage and has not developed outside the larynx, it can usually be retained; if the tumor has developed outside the larynx and invaded the adjacent tissues, an extended resection is performed to remove part of the tongue root, part of the thyroid gland, or part of the hypopharyngeal mucosa.

3. Treatment of cervical lymph node metastasis Since laryngeal cancer mainly metastasizes through cervical lymph nodes, patients with cervical lymph node metastasis should also undergo cervical lymph node dissection. It is generally believed that supraglottic laryngeal cancer has a high rate of lymph node metastasis, so selective neck dissection or zonal neck lymph node dissection should also be performed for supraglottic laryngeal cancer with no clinically found lymph node enlargement.