Our Summary

This research paper compares two treatments for advanced laryngeal cancer: organ preservation (OP) and total laryngectomy (removal of the larynx). The study looked at patients who received either treatment between 2000 and 2018.

The results showed that the overall survival rate was similar for both groups. However, for patients with a specific stage of cancer (T3), those who underwent OP treatment had a higher chance of the cancer coming back. Of these, almost 30% experienced local recurrence, compared to just over 7% of those who had a total laryngectomy.

Interestingly, the study found that those patients who had OP treatment and then needed surgery due to a recurrence of the cancer had a similar survival rate to those who had a total laryngectomy from the start. However, around 40% of the patients whose cancer came back after OP treatment were not suitable for a laryngectomy.

In terms of quality of life, around 75% of patients who had a total laryngectomy were able to eat a normal diet, compared to 54% of those who had OP treatment. Also, nearly 90% of patients who had a total laryngectomy had understandable speech, with the help of a tracheoesophageal prosthesis (a device to help them speak).

The study concludes that there was no difference in survival for patients with the most severe stage of cancer (T4), which might be due to carefully selecting the right patients for each treatment. However, the chance of the cancer coming back was higher in T3 patients who had OP treatment. The study also finds that patients who had a total laryngectomy had similar swallowing and speech outcomes to those who had OP treatment.

FAQs

  1. Is there a difference in survival rates between patients who receive a total laryngectomy and those who undergo organ preservation for laryngeal cancer?
  2. What are the rates of local recurrence in T3 patients who receive organ preservation versus a total laryngectomy?
  3. How do the swallowing and speech outcomes compare between patients who have a total laryngectomy and those who undergo organ preservation treatment?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to follow a strict follow-up schedule and report any changes in speech, swallowing, or breathing immediately. Regular monitoring can help detect any potential issues early and improve the chances of successful treatment. Additionally, it is important for patients to follow any recommendations for speech therapy and rehabilitation to help improve communication and swallowing function after the procedure.

Suitable For

Patients with advanced laryngeal cancer, specifically T3 stage, are typically recommended laryngectomy, either total laryngectomy or organ preservation treatment. Patients who are not candidates for organ preservation due to the extent of their disease or other factors may also be recommended for laryngectomy. Additionally, patients who have failed organ preservation treatment and have local recurrence may also be recommended for salvage laryngectomy. Ultimately, the decision to recommend laryngectomy for a patient with laryngeal cancer will depend on the individual’s specific case and factors such as the stage of the cancer, overall health, and treatment goals.

Timeline

Before laryngectomy, a patient may experience symptoms such as hoarseness, difficulty swallowing, ear pain, or a persistent cough. They may undergo various diagnostic tests such as imaging scans, biopsies, and endoscopies to confirm the presence of laryngeal cancer. Treatment options including chemotherapy, radiation therapy, and organ preservation approaches may be discussed with the patient.

After laryngectomy, the patient will undergo surgery to remove their larynx, which may result in changes to their ability to speak, swallow, and breathe. Patients may require rehabilitation and speech therapy to learn how to communicate using alternative methods such as a tracheoesophageal prosthesis or electrolarynx. They may also need to adjust to changes in their diet and lifestyle to accommodate for the loss of their larynx. Follow-up care will involve regular monitoring for recurrence of cancer and addressing any complications or side effects of treatment.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a laryngectomy procedure?
  2. How will a laryngectomy impact my ability to speak and swallow?
  3. What are the long-term effects of a laryngectomy on my quality of life?
  4. Will I need any additional treatments (such as chemotherapy or radiation therapy) after a laryngectomy?
  5. How often will I need follow-up appointments and what will be involved in my post-operative care?
  6. What support services are available to help me cope with the physical and emotional challenges of a laryngectomy?
  7. What are the chances of the cancer returning after a laryngectomy compared to other treatment options?
  8. How will a laryngectomy affect my ability to eat and drink normally?
  9. Are there any alternative treatments or procedures that may be suitable for my condition?
  10. How soon after a laryngectomy can I expect to resume normal activities and return to work?

Reference

Authors: Lee MY, Belfiglio M, Zeng J, Fleming CW, Koyfman S, Joshi NP, Lamarre E, Prendes B, Scharpf J, Lorenz RR, Woody NM, Adelstein DJ, Geiger JL, Chute DJ, Ku JA. Journal: Laryngoscope. 2023 May;133(5):1122-1131. doi: 10.1002/lary.30254. Epub 2022 Jun 26. PMID: 35754153