What are the surgical methods for treating laryngeal cancer?

There are many surgical methods for laryngeal cancer, which are mainly designed around long-term efficacy and functional recovery. At the same time, they are also improved as people's understanding of laryngeal cancer continues to advance. Historically, the choice of surgical methods for laryngeal cancer has also undergone a process of continuous change. The current general principle is to appropriately consider functional recovery and reconstruction based on the premise of ensuring complete and clean resection of the lesion, based on the primary site of the cancer, clinical manifestations, and pathological types, because this is more beneficial to the patient's prognosis. Now, regarding the selection and effects of commonly used surgical methods, experts introduce the following methods of surgical treatment of laryngeal cancer.

1. Hemilaryngectomy and partial laryngectomy

Depending on the location of the lesion, hemilaryngectomy includes anterolateral hemilaryngectomy, supraglottic horizontal hemilaryngectomy, anterolateral hemilaryngectomy and 3/4 laryngectomy. It is mainly suitable for patients with vocal cord cancer that has spread to the vocal process, one side of the vocal cord has exceeded the anterior commissure, vocal cord cancer has developed below the glottis, or one side of the vocal cord cancer has not disappeared after radiotherapy. Supraglottic horizontal hemilaryngectomy is suitable for patients with epiglottic cancer, laryngeal vestibule and laryngeal ventricular zone cancer, epiglottic lingual surface and tongue root cancer, or epiglottic cancer that has not completely disappeared after radiotherapy.

The reconstruction of laryngeal function is mainly for pronunciation and breathing functions, but whether it is hemi-laryngectomy or partial laryngectomy, it must be done under the premise of complete removal of the tumor. Practice has shown that the 5-year survival rate after hemi-laryngectomy or partial laryngectomy is not inferior to that of total laryngectomy. In addition, some functions are retained. After a lot of practice, many doctors believe that patients with T2 and T3 laryngeal cancer can avoid total laryngectomy by choosing the method of partial resection. The 3-year and 5-year survival rates are 78% and 58% respectively, while the 3-year and 5-year survival rates of total laryngectomy are 54%. However, since this operation requires the retention of some laryngeal tissues to varying degrees, it requires a certain amount of experience during the operation, especially in the estimation of the scope of the lesion, the determination of the clinical stage and the design of the resection range. Otherwise, the recurrence rate after surgery will increase. Many clinical scholars believe that the local recurrence rate of hemi-laryngectomy or partial laryngectomy is about 10%. Among the patients with recurrence, most are related to the original site of the cancer and the surgical method. In terms of location, the recurrence rate of transglottic type is the highest, reaching 31.3%. The recurrence rate of supraglottic resection is the highest, reaching 42.9%. About 50% of the recurrences are due to deep infiltration.

2. Total laryngectomy

Total laryngectomy was first performed in 1873, and the first total laryngectomy for laryngeal cancer was successful. Since then, total laryngectomy has been considered a radical surgical procedure for laryngeal cancer and has always dominated clinical practice. Especially after the advent of antibiotics, the mortality rate of surgery has been greatly reduced, making its clinical application more extensive. Although hemi-laryngectomy and partial laryngectomy have been widely performed, total laryngectomy is still the main surgical method for laryngeal cancer treatment.

Total laryngectomy is applicable to a wide range of patients, including patients with clinical stage III and IV, such as those whose tumor occupies one or both vocal cords and has fixed vocal cords; those with obvious invasion of the anterior commissure and may have spread to the subglottic area; supraglottic ventricular cancer, epiglottal cancer, or subglottic cancer, and other types of malignant tumors of the larynx.

The advantage of total laryngectomy is that the cancerous tissue is removed relatively thoroughly, and the chance of local recurrence is relatively small. Its disadvantages and shortcomings are that the surgery causes the patient to lose the larynx for life, lose normal language, and cannot guarantee the normal physiological respiratory pathway, which is indeed regrettable for some patients with limited early lesions. In addition, the incidence of pharyngeal fistula after total laryngectomy can reach 14.8% to 17.8%, and about 50% of patients need to wear a tube for a long time. For the problem of postoperative aspiration, some patients need to go through a long period of training and adaptation to solve it, and sometimes they need to pay great patience and perseverance. These reductions in quality of life may directly affect the patient's quality of life and survival time.

There are many factors that determine the efficacy of total laryngectomy, but they are mainly determined by the primary site of the tumor, clinical stage, histological type of the lesion, presence or absence of metastasis, the surgeon's clinical experience and the selected surgical procedure.

(III) Treatment of cervical lymph nodes

The ultimate main cause of death in laryngeal cancer patients is cervical lymph node metastasis or lung metastasis. Therefore, whether laryngeal cancer patients should undergo routine cervical lymph node dissection (neck dissection for short) is a practical problem faced in clinical practice. However, so far, there are still different opinions on how to choose the indications and when to perform neck dissection. Now we discuss various different opinions as follows.

There is indeed controversy over whether routine preventive neck dissection should be performed for N0 patients with no palpable lymph nodes clinically. Glottic cancer metastasis occurs late, and less than 5% of patients have metastasis at the time of surgery. Therefore, some people advocate that for glottic cancer, patients with no palpable lymph node enlargement in the neck can be observed without routine dissection. However, for supraglottic and subglottic types, due to the rich local blood supply and lymphatic distribution, supraglottic cancer is generally poorly differentiated and has a greater chance of cervical lymph node metastasis. The rate of metastasis at the time of surgery is about 40% for supraglottic type and 13% to 20% for subglottic type. Therefore, a positive attitude should be taken towards supraglottic cancer, and it is advocated that routine preventive dissection should be performed for supraglottic cancer.

Therefore, in recent years, most people advocate therapeutic clearance, which preserves the sternocleidomastoid muscle, jugular vein, accessory nerve and other soft tissues while completely removing suspicious lymph nodes. Literature suggests that this not only has less impact on patients, but is also conducive to postoperative recovery, and the 5-year survival rate has not decreased.

The above is an introduction to "What are the surgical methods for treating laryngeal cancer?" For people who are related to the pathogenic factors of laryngeal cancer, it is recommended to take preventive measures against laryngeal cancer. If you have other questions about laryngeal cancer, please consult our experts online or call for consultation.

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