Effect of age and surgical access on the maintenance of laryngeal function in laryngeal carcinomas

Introduction:

This study aimed at evaluating the importance of age for decision making concerning indication of surgical approach (transoral vs. transcervical surgery) in glottic and supraglottic laryngeal carcinomas. In addition, the effect of age and surgical approach on the preservation of laryngeal function was examined.

Methods:

1588 patients who underwent a partial laryngectomy (transoral laser resection n = 1024, transcervical partial laryngectomy n = 564) in the period 1990 – 2017 as primary therapy in glottic (n = 1191) or supraglottic (n = 397) laryngeal carcinoma were evaluated retrospectively.

Results:

After organ-preserving surgical therapy, 45.1% of patients experienced a temporary dysphagia, a permanent loss of swallowing function (permanent tracheostoma or permanent nutrition via PEG) in 24.5% of patients with supraglottic laryngeal carcinoma (97/397). Swallowing function was highly significantly worse after transcervical resection in comparison to transoral surgery by supraglottic carcinomas (p < 0.001). The functional outcome was independent of age (p < 0.001), with transoral laser surgery being significantly more frequently indicated, especially in supraglottic carcinoma, at an advanced age (p < 0.001).

Conclusion:

Based on our data, we recommend a transoral laser surgical procedure to the transcervical procedure whenever possible in the organ-preserving surgical therapy of the laryngeal carcinoma in advanced age. Properly indicated laser surgery contributes to preservation of swallowing function and thus quality of life.

Publication History

Publication Date:
23 April 2019 (online)