Results of total laryngectomy as treatment for locally advanced laryngeal cancer in the organ-preservation era

Introduction and objectives: Total laryngectomy (TL) and postoperative radiotherapy (RT), when indicated, have proven to be effective in treating cases of locally advanced laryngeal cancer. The aim of this study was to analyse the oncological outcomes of this procedure in patients with laryngeal cancer classified T3 and T4a. Methods: We studied 80 patients (51 T3 and 29 T4a) with primary squamous cell carcinoma of the larynx who underwent TL between 1998 and 2006. Bilateral neck dissection was performed in 54 patients, unilateral in 11, and central in 4. Twenty patients (25%) received postoperative radiotherapy. Results: Mean age was 64 years with a male predominance (97%). As for habits, 96% were smokers and 89% consumed alcohol. Lymph node metastases occurred in 44% of patients and extracapsular invasion in 37% of them. All cases had tumour-free margins. In all, 25% of patients had loco-regional recurrence and 5% developed distant metastases. The 5-year disease-specific survival was 72% and 5-year overall survival was 55%. Variables associated with decreased disease-specific survival were T4 classification (P= .060). N2-N3 classifications (P= .005). extra capsular invasion (P= .018) and stage iv disease (P= .009). On multivariate analysis, the only variable associated with decreased disease-specific survival was the presence of N2-N3 nodal metastases (P= .008). Conclusions: TL is an effective treatment for the management of patients with locally advanced laryngeal cancer. Organ preservation protocols should achieve similar oncological results to those obtained with TL. (C) 2014 Elsevier Espana, S.L.U. y Sociedad Espanola de Otorrinolaringologia y Patologia Cervico-Facial. All rights reserved.