Positive surgical margins in cancer of the larynx

In order to determine what should be done for laryngeal cancer patients when surgical margins are positive, and to evaluate their prognosis, a retrospective review of 21 laryngeal cancer patients with positive surgical margins out of 714 surgically treated cases (2.9%) was carried out. Nineteen patients were treated with postoperative radiation therapy. Two patients who had had endolaryngeal partial laryngectomy were treated with vertical partial laryngectomy. Two patients were lost to follow-up. Ten patients (10/19; 53%) were recurrence-free. Four patients had local, two had regional, and two had locoregional recurrences. Only one patient with a local recurrence could be salvaged with total laryngectomy and is disease-free. One patient developed liver metastasis. Nineteen patients had a mean and median disease-free survival of 48 and 36 months, respectively. Nine out of fourteen patients (64%) treated curatively were recurrence-free. The patients with positive margins developed significantly more locoregional recurrences than those with free margins (P < 0.05). We conclude that surgical margins must be checked peroperatively with frozen sections to make sure that they are free. The margins of every laryngectomy specimen must be diligently examined. If positive, re-excision, postoperative radiotherapy and chemotherapy are treatment alternatives. They should not just be managed with close follow-up. However, whatever treatment is applied, the prognosis for patients with positive margins is significantly worse than for those with free margins. Received: 18 August 2000 / Accepted: 23 January 2001     

Prognostic role of resection margin in open oncologic laryngeal surgery: survival analysis of a cohort of 139 patients affected by squamous cell carcinoma

IntroductionThe treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin.ObjectiveTo evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis.MethodsBetween 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44 ± 28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors.Results45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to pN (HR = 5.043; p = 0.015) and recurrence (HR = 11.586; p = 0.012). Resection margin did not result an independent predictor (HR = 0.757; p = 0.653).ConclusionsOur study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices.     

Resultados oncológicos de la laringectomía de rescate en pacientes con carcinomas escamosos de laringe

ObjectiveTo analyse the oncological results of a salvage total laryngectomy in patients with a laryngeal carcinoma.Material and methodsRetrospective review of a cohort of 241 patients treated with a salvage laryngectomy after a local recurrence. The initial treatment received by these patients was radiotherapy (n = 201, 83.4%), chemoradiotherapy (n = 19, 7.9%), and partial surgery (n = 21, 8.7%),ResultsTotal laryngectomy as salvage treatment achieved local control of the disease in 81.3% of cases, with a 5-year specific survival of 65.3%. The variables related with specific survival in a univariate analysis were the location of the primary tumour, the local extension of the initial tumour and of the recurrence, the resection margins, and the pathological status of the neck dissections. According to the results of a multivariate analysis, the variables related to specific survival were the status of the resection margins, the presence of simultaneous regional recurrence, and the local extension of the recurrence.ConclusionThe 5-year specific survival of patients treated with a salvage laryngectomy was 65.3%. The variables related with the control of the disease were the status of the resection margins, the presence of simultaneous regional recurrence and the local extension of the recurrence.     

Oncological outcomes of surgical treatment for T3 supraglottic laryngeal squamous cell carcinoma patients

Abstract

Background: T3 supraglottic laryngeal carcinoma (LC) is a common advanced laryngeal cancer.

Objective: This study was conducted to assess the clinical results of pathological T3 (pT3) supraglottic LC patients who were amenable to laryngectomy treated with primary surgery and postoperative therapy.

Methods: Retrospective review of 202 pT3 cases of supraglottic laryngeal squamous cell carcinoma.

Results: The five-year cancer specific survival (CSS) rate was 63.7% and the overall survival rate (OS) was 62.8%. For T3 supraglottic patients who underwent total laryngectomy, the five-year disease-free survival (DFS) was 51.8%, and the CSS was 62.5%. For patients who underwent partial laryngectomy, the five-year DFS was 72.2%, and the CSS was 79.0%. High lymph node and stage status are predictors of mortality for these patients. No difference was found in the DFS and CSS rates between patients with negative margins and those with positive margins following postoperative radiotherapy and chemotherapy.

Conclusion: Surgical treatment of T3 supraglottic LC patients achieved satisfactory results. Postoperative radiotherapy and chemotherapy are an effective method of treatment for T3 supraglottic LC patients, especially for those with a positive margin.     

The impact of positive resection margins in partial laryngectomy for advanced laryngeal carcinomas and radiation failures

Clin. Otolaryngol. 2010, 35 , 402–408 Objectives: To investigate the prognostic significance of positive margin and disease course in partial laryngectomy for advanced laryngeal carcinoma and radiation failure. Design: Retrospective case control study. Setting: A major tertiary referral centre. Participants: Patients who underwent partial laryngectomy for advanced laryngeal carcinoma or for radiation failure with at least 2 years of follow-up . Main outcome measures: Margin status versus primary treatment and salvage treatment versus disease-free survival and overall survival. Results: Twenty nine patients with sufficient follow-up data were found. Twelve patients had histological positive margin. Five of the 12 patients with a histological positive margin failed surgery as did four patients with clear margins. A positive margin had no effect on disease-free survival (P = 0.287) but was associated with poorer overall survival (P = 0.051). Of 11 patients treated primarily with surgery, recurrence was documented in one of eight with a positive margin and none of three with clear margins. Of 18 patients who underwent surgery secondary to radiation failure, recurrence was documented in all four with a positive margin and 4 of 14 with negative margins. Extended frontolateral resection, performed only in radiation failures, was associated with worse disease-free survival. Conclusions: Non-irradiated patients with involvement of a single margin after partial laryngectomy may be spared total laryngectomy if adjuvant radiation is administered. Patients who fail radiation should undergo radical partial laryngectomy, with conversion to total laryngectomy in those with a positive margin.     

Successful 10-year outcomes after supracricoid partial laryngectomy for selected glottic squamous cell carcinoma classified as T3N0M0: A STROBE analysis

PurposeTo evaluate long-term oncological outcome for patients with selected glottic squamous cell carcinoma (SCC) classified as T3N0M0 treated by supracricoid partial laryngectomy (SCPL).Materials and methodsAnalysis of an inception cohort of 46 patients with isolated untreated SCC classified as T3N0M0 and minimum 10-year follow-up, consecutively treated by SCPL between 1982 and 2012 in a French university teaching hospital. The main endpoint was 5- and 10-year actuarial survival and local control estimates. Accessory endpoints comprised cause of death, screening for variables decreasing survival and increasing risk of local recurrence, oncologic consequences of local recurrence, and laryngeal preservation rate.ResultsFive- and 10-year actuarial survival was 78.1%, and 53.3%, respectively. The main causes of death were intercurrent disease and metachronous second primary, each in 33.3% of cases. Postoperative mortality (aspiration pneumonia) was 2.1%. There were no significant correlations between survival and any study variables. Five- and 10-year local control was 90.5%. Overall local recurrence varied significantly (P = 0.003), from 2.3% with negative margins (R0) to 100% with positive margins (R1) and/or dysplasia. Local recurrence was associated with a significantly (P < 0.005) increased risk of nodal failure and distant metastasis, and reduced survival. Overall laryngeal preservation was 89.1%.ConclusionThe present results suggest that SCPL should continue to be taught and that this type of partial laryngeal surgery should be included in the various organ-sparing strategies considered in advanced laryngeal cancer.     

Laser resection of T1a glottic carcinomas: results and postoperative voice quality

Objectives—To calculate recurrence, mortality and complication rates and evaluate postoperative voice quality after laser resection of T_1a glottic carcinoma.

Material and Methods—Since 1995 we have treated 118 patients with a T_1a glottic carcinoma with laser surgery. In order to evaluate postoperative voice quality, patients who were alive and free of recurrence were sent the Voice Handicap Index (VHI) questionnaire containing 30 questions concerning how their voice affects their daily life physically, emotionally and socially.

Results—Twelve patients (10%) had a local recurrence and received further treatment, either a second laser treatment, radiotherapy or a total laryngectomy. One patient (0.84%) died due to the laryngeal cancer. Ninety-nine patients were sent the VHI questionnaire and 94 of the completed questionnaires were included in the study and analyzed. The mean total score was 13.2, with mean subscores of 6.5 (physical), 4.1 (functional) and 2.5 (emotional).

Conclusions—The results indicate that these patients as a group do not consider that their voice has a negative impact on their daily life. Good surgical technique is essential to obtain a good functional result. The laser strength should be kept low and the surgical margins small in order to minimize scarring and vocal cord stiffness.     

The role of red cell distribution width in the locoregional recurrence of laryngeal cancer

IntroductionAlthough the red cell distribution width has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge few reports have focused on the prognostic value of red cell distribution width in laryngeal carcinoma.ObjectiveWe aimed to explore whether the pretreatment red cell distribution width predicted recurrence in laryngeal cancer patients is a simple, reproducible, and inexpensive prognostic biomarker.MethodsAll laryngeal cancer patients who underwent curative surgery (n = 132) over a 7 year study period were evaluated. Data on demographics, primary tumor site, T-stage, N-stage, histological features (differentiation; the presence of perineural/perivascular invasion), treatment group (total laryngectomy or partial laryngectomy) or adjuvant therapy (chemotherapy/radiotherapy); laboratory parameters (complete blood count, including the pre-operative red cell distribution width), and disease-free survival rates were retrospectively reviewed. All cases were divided into three groups by the red cell distribution width tertile [<13% (25th percentile) (n = 31), 13–14.4% (50th percentile) (n = 72), and >14.4% (75th percentile) (n = 29)].ResultsHigh-red cell distribution width group included more patients of advanced age, and more of those with recurrent and metastatic tumors (p = 0.005, 0.048, and 0.043, respectively). Individuals with red cell distribution width >14.4% (75th percentile) had lower disease free survival rates than did those with red cell distribution width <13% (25th percentile) (p = 0.014). Patients with red cell distribution width >14.4% at diagnosis were at a higher risk of locoregional recurrence (hazard ratio = 5.818, 95% confidence interval (95% CI) 1.25–26.97; p = 0.024) than patients with a normal red cell distribution width (<13%).ConclusionWe found that the pretreatment red cell distribution width was independently prognostic of disease free survival rate in patients with laryngeal cancer and may serve as a new, accurate, and reproducible means of identifying early-stage laryngeal cancer patients with poorer prognoses.     

Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) in the management of laryngeal carcinoma: oncologic results. A 35-year experience

To evaluate the long-term oncologic results of supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) for laryngeal cancer. A 35-year retrospective study concerning 291 patients treated by supracricoid laryngectomy with CHEP for laryngeal cancer was performed. The following postoperative data were studied: recurrence rates (lymph node and laryngeal), distant metastases and second cancer. The mortality rate and overall survival were estimated by the Kaplan–Meier method. The postoperative mortality was 1.03 %. 23 patients were lost to follow-up. The 3-year survival rate was 84 % and the 5-year survival rate was 80 %. 12 patients developed distant metastasis. 31 patients developed a second cancer. The local (laryngeal) control rate was 93.94 % and the regional (cervical lymph node) control rate was 92.05 %. In multivariate analysis, the occurrence of a second non-ENT cancer and metastasis as well as margins involvement were reliable to mortality. Supracricoid laryngectomy with CHEP appears to be associated with very good long-term oncologic results and still has a place in the management of T1, T2 and selected T3 glottic cancers.     

Assessment of preoperative psychologic distress in laryngeal cancer patients

Background: Preoperative psychologic distress is common in head and neck cancer patients and related to deleterious effects in patient treatment and recovery. Routine screening and appropriate referral of all patients with cancer for psychiatric assessment is now a part of the medical treatment.

Objects: The aim was to assess the level of preoperative psychologic distress in laryngeal cancer patients scheduled for surgical treatment.

Methods: After the Institutional Review Board approval and informed written consent, 211 patients scheduled for total or partial laryngectomy were interviewed preoperatively. Each patient was asked to fulfil the Hospital Anxiety and Depression Scale. Demographic characteristics that may relate to psychologic distress were also recorded.

Results: The mean age (+/?SD) was 62.1 (8.2) years. The surgical type was total laryngectomy (n?=?79) and partial laryngectomy (n?=?132). Median (first/third quartile) HADS score was 6 (3/10). A total of 39.6% patients had psychologic distress. The HADS score was higher for total laryngectomy patients than partial laryngectomy patients [7 (4/10) versus 5 (3/10), p?<?.05]. Age was negatively correlated with HADS score (p?=?.049).

Conclusions: Our study showed that laryngeal cancer patients scheduled for total laryngectomy had higher level of psychologic distress. Age was a predictive factor for psychologic distress.     

Salvage resection after previous laryngeal surgery: total laryngectomy with en bloc resection of the overlying cervical skin.

OBJECTIVE: To evaluate the effectiveness of extended total laryngectomy for the treatment of recurrences of laryngeal cancer. DESIGN: We conducted a retrospective clinical study of patients who had undergone extended total laryngectomy and were seen over a 15-year period. The follow-up period ranged from 3 to 15 years. SETTING: Academic tertiary referral medical center. PATIENTS: We observed 15 patients who were affected by a recurrence of laryngeal cancer that extended to the overlying soft tissue. All patients were male. The mean age was 61.5 years. Thirteen patients had previously undergone partial laryngeal surgery, and 2 patients had undergone radiation therapy, without success. INTERVENTION: All patients underwent total laryngectomy extending to the soft tissue, including the overlying skin. RESULTS: Five of the 15 patients died of local recurrence, and 1 patient died of massive postoperative hemorrhaging. An actuarial survival rate of 60% was observed at 5 years. CONCLUSION: Total laryngectomy extending to the soft tissues seems to be an effective procedure for treating local recurrences of laryngeal cancer after partial laryngectomy or failure of radiation therapy.     

1115例喉癌患者的生存分析

目的 了解20世纪80～90年代外科治疗喉癌的远期效果，并且探讨影响预后的因素。方法 应用回顾性调查的方法，对1983～1996年间中国医科大学第一附属医院耳鼻咽喉科1115例喉癌患者进行分析，统计患者的生存率和死亡原因。结果 生存5年以上者780例，死亡260例，失访75例，累积生存率曲线统计5年生存率为77％，其中Ⅰ期为94％、Ⅱ期为89％、Ⅲ期为82％、Ⅳ期为66％。不同分型的5年生存率由高到低的顺序是声门型、声门上型、声门下型、跨声门型。喉部分切除术患者的5年生存率为85％，而喉全切除术患者的5年生存率为68％。患者5年内死亡的主要原因是局部复发和转移(70％)，另有14％的死亡者没有弄清他们的死亡原因。结论 近20年我国喉癌治疗水平得到明显提高，早期诊断是提高喉功能保留手术比例和提高生存率的关键，患者5年内死亡的原因主要是局部复发和转移。     

喉近全切除术的扩大适应证

目的进一步总结喉近全切除术的经验。方法选择Ｔ３、Ｔ４喉鳞状细胞癌５７例行喉近全切除术。结果术后发音成功率９３％，３年生存率为６７．５％，下咽癌为５０％，局部复发率仅３．５％。其适应征为不适宜常规部分喉切除的喉癌；还可应用于舌根口咽癌、梨状窝癌、颈段食管癌等。结论只要适应证选择得当，喉近全切除术是一种手术方法不过繁、安全、减少无喉残废的方法。     

Comprehensive analysis of pharyngeal recurrence of laryngeal carcinoma after total laryngectomy

Purpose: This study analyzes the incidence, risk factors, treatment results, and prognosis of local recurrence at the pharynx after total laryngectomy for laryngeal carcinoma.Patients and Methods: The records of 292 patients who underwent total laryngectomy for the treatment of laryngeal carcinoma between January 1978 and December 1990 were reviewed.Results: Of these 292 patients, there were 24 patients who developed local recurrence at the pharynx. The 5-year actuarial cumulative local recurrence rate was 10%. There were 17 cases of pharyngeal recurrence alone, five cases of pharyngeal and nodal recurrence, one case of pharyngeal and tracheostomal recurrence, and one case of pharyngeal and distant metastasis. Ten (42%) patients were salvaged surgically; the 5-year actuarial survival rate after surgical salvage was 53%. The other 14 patients were treated with palliative treatment, and all died of tumor, with the longest period of survival being 28 months.Conclusion: Surgical salvage of pharyngeal recurrence has acceptable results. Close monitoring of patients is important to have an early diagnosis of salvageable recurrence.     

Near-total laryngectomy for laryngeal carcinomas with subglottic extension

OBJECTIVE: To investigate whether Pearson classic near-total laryngectomy is a sensible surgical treatment modality for laryngeal carcinomas with subglottic extension. DESIGN: Retrospective analysis of patients treated by near-total laryngectomy in a university hospital that is an academic tertiary health care center. PARTICIPANTS AND INTERVENTION: Medical and computer records of 135 patients who were treated by near-total laryngectomy for laryngeal and hypopharyngeal carcinomas between April 1, 1989, and June 30, 2000, were searched thoroughly, and the final outcomes were confirmed by telephone contact. MAIN OUTCOME MEASURES: Survival rates of the patients with laryngeal carcinomas with subglottic extension treated by near-total laryngectomy were compared with those of the patients with malignancies of other laryngeal regions given the same treatment. RESULTS: Of the 135 patients in the study, 74 were available for determination of 5-year survival. The rate was 65.8% (27/41) for transglottic tumors, 53.8% (7/13) for supraglottic tumors, and 20.0% (4/20) for tumors with subglottic extension. Only 3 of 16 patients with laryngeal carcinomas with supraglottic or transglottic localization died of local recurrence; the rest of the deaths were from regional recurrence or distant metastasis. However, 6 of 13 patients with subglottic extension died of local recurrence, 5 of peristomal recurrence, and only 2 of distant metastasis. CONCLUSIONS: Success was directly related to adherence to precise indications in cancer surgery. While near-total laryngectomy is an effective and reliable treatment modality in laryngeal cancer surgery, its effectiveness in laryngeal cancers with subglottic extension is debatable. These subglottic lesions should be treated by total laryngectomy, which is a more radical surgery.     

Use of concurrent chemoradiation in advanced staged (T4) laryngeal cancer

Hypothesis

Patients with advanced laryngeal cancer sometimes desire organ preservation protocols even if it portends a worse outcome.

Resultados de un protocolo de preservación de órgano en pacientes con tumores localmente avanzados de la laringe

Introduction and objectivesAdvanced laryngeal carcinoma patients, candidates for total laryngectomy, nowadays have different treatment options. One of them is induction chemotherapy, which allows modulation of the second manoeuvre according to the degree of response achieved. This study presents the results of a large series of patients treated according to this protocol.MethodsRetrospective study of 370 patients with T3-T4 carcinomas of the larynx considered as candidates for total laryngectomy. All patients were treated with the protocol mentioned above.ResultsSeven patients died as a consequence of the treatment with chemotherapy. Among 363 patients finishing chemotherapy, 154 (43 %) achieved complete response and proceeded with radiotherapy. Total laryngectomy was performed in 135 (37 %) non-responders and 74 (20 %) patients were treated with radiotherapy in spite of an incomplete response to chemotherapy. Overall actuarial survival was 73 % at five years. Survival for patients with complete response and treated with radiotherapy was 77 % and for non-responders subjected to total laryngectomy it was 76 %. Non-responders treated with radiotherapy had a 5-year survival rate of 64 %, significantly different to both other groups (p = 0.01). Larynx preservation was achieved in 42 % of the patients, rising to 72 % for complete responders to chemotherapy and to 62 % in non-responders receiving radiotherapy.ConclusionsOur larynx preservation protocol including induction chemotherapy for patients with advanced carcinomas who are candidates for total laryngectomy achieved a total survival rate of 73 % with a 42 % larynx preservation rate. The response to the induction chemotherapy was the factor contributing most to larynx preservation.     

Management and outcome of glottic cancer: a population-based comparison between Ontario, Canada and the SEER areas of the United States. Surveillance, Epidemiology and End Results

OBJECTIVE: We compared treatment practice and outcome in glottic cancer in Ontario, Canada to that in the Surveillance, Epidemiology and End Results (SEER) program areas in the United States to determine whether the Ontario emphasis on the use of delayed combined therapy was associated with similar survival and better laryngectomy-free survival than the U.S. approach, which emphasizes greater use of surgery. METHODS: Electronic, clinical, and hospital data were linked to cancer registry data. The study groups compared on survival comprised all patients diagnosed from 1982 to the end of 1991 in Ontario (2324 patients) and in the SEER areas (5715 patients). Comparisons on initial treatment, laryngectomy rates, and laryngectomy-free survival were limited to subsets of these study populations due to data availability. Initial treatment data were provided by the SEER registries in the U.S. and by the cancer clinic and hospitalization data in Ontario. Information about laryngectomies performed subsequent to initial treatment was available from Medicare hospitalization data in the U.S. and from Canadian Institute for Health Information hospitalization data in Ontario. RESULTS: Although radiotherapy was the most common initial treatment in both areas, it was used more often in Ontario (84.4% versus 63.2% in the U.S. [p < 0.001]). Relative survival was not statistically different with a relative risk comparing SEER to Ontario of 1.09, 95% confidence interval (CI) (0.93, 1.29). Laryngectomy rates were similar with a relative risk of 1.01, 95% CI (0.67, 1.52), and it follows from the survival and laryngectomy rate comparisons that the laryngectomy-free survival was not statistically different (p = .95). CONCLUSIONS: There are large differences in the management of glottic cancer between the U.S. and Ontario and no corresponding differences in survival or laryngectomy-free survival. This work highlights a need for more clinical investigation into the relative merits of differing management policies in glottic cancer.     

Well and intermediate differentiated laryngeal chondrosarcoma: toward conservative surgery?

Chondrosarcoma of the larynx is a relatively rare malignant tumor. In the world literature, only 600 cases of laryngeal chondrosarcoma (LCS) have been reported. It is the most frequent non-epithelial tumor of the larynx (0.07–2 % of all cancers), usually occurring on the cricoid. We present six cases of well–intermediate differentiated grade chondrosarcoma of the larynx, diagnosed between the fifth and seventh decades of life, in the absence of relevant risk factors. All cases were subjected to a conservative surgical approach, either endoscopic using remodeling transoral laser surgery, or open neck via a supratracheal partial laryngectomy (STL), sparing laryngeal function. All patients are free from recurrence with a minimum follow-up of 31 months. All were ultimately decannulated, are able to tolerate a quite normal diet and to speak satisfactorily. Conservative laryngeal surgery is effective because chondrosarcoma is often a low-grade tumor showing slow growth. The criteria for choosing the type of surgery was based on the age of the patient (elderly patient > favoring an endoscopic approach), on the rate of involvement of the cricoid and on the involvement of the cricoarytenoid joints (if possible to save a cricoarytenoid unit > favoring a STL). By extending the inferior limit of the resection to include a large part of the cricoid cartilage, supratracheal partial laryngectomies expanded the indications to some LCSs not involving the entire cricoid lamina sparing laryngeal function and avoiding the need for total laryngectomy.     

The incidence of thyroid gland invasion in advanced laryngeal squamous cell carcinoma

IntroductionInvasion of the thyroid gland is not a general feature of advanced laryngeal carcinoma. There is no need for performing thyroidectomy in all total laryngectomy cases.ObjectivesTo evaluate the frequency of the thyroid gland invasion in patients with advanced laryngeal squamous cell carcinoma submitted to total laryngectomy and thyroidectomy and to determine whether clinical and pathological characteristics of laryngeal carcinoma can predict glandular involvement.MethodsA retrospective case series with chart review, from March 2009 to January 2018, was undertaken in the the Princess Norah Oncology Center, King Abdul-Aziz Medical City, Jeddah/KSA. An inception cohort of 56 patients with laryngeal squamous cell carcinoma was considered. Nine cases were excluded. All patients had advanced stage cancer of the larynx (clinically T3‒T4) and underwent total laryngectomy in association with thyroidectomy. Total thyroidectomy was performed in all bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. The frequency of thyroid gland invasion was calculated and analysis of demographic, clinical and pathological characteristics associated with thyroid gland invasion was performed.ResultsIn all, 47 patients underwent total laryngectomy (40 treated with primary laryngectomy and seven treated with salvage laryngectomy following radiation failure or chemoradiation failure). Hemithyroidectomy was performed in 42 patients and the total thyroidectomy was performed in five patients. The overall frequency of invasion of the thyroid gland was 4.3%. Glandular involvement was seen in one advanced transglottic squamous cell carcinoma and one subglottic. In spite of thyroid cartilage invasion in 25.5% of cases detected in the preoperative radiological imaging, only one case demonstrated microscopic thyroid gland invasion.ConclusionsThyroidectomy may only be required during total laryngectomy for selected cases of advanced transglottic tumors and tumors with subglottic extension more than 10 mm.