Our Summary

The research paper discusses a new minimally invasive technique for performing total laryngectomy (removal of the voice box), known as Trans-oral total laryngectomy (TOTL). The researchers looked at data from January 2009 to December 2023 from various databases to understand the outcomes and potential complications of this procedure, which can be performed with the help of robots or endoscopes.

They analyzed data from eight studies involving 37 patients. Most of these procedures were performed for laryngeal SCC (a type of throat cancer), using either robotic assistance (31 cases), endoscopic assistance (3 cases), or a combination of both (3 cases).

The results showed that the surgical area could be closed successfully in all patients, and in 20 out of 21 patients with LSCC, the surgery was successful in removing all cancerous tissue. However, disease recurrence was reported in 4 out of 20 LSCC patients (20%). Complications occurred in about a third of the cases (33.7%), including fistula (an abnormal connection between two body parts), bleeding, and stomal stenosis (narrowing of the opening in the neck).

The study concludes that while TOTL is a promising new approach for patients requiring total laryngectomy, and it causes less damage to tissue than traditional methods, more research is needed to better understand its outcomes and potential complications. This is the first detailed analysis of its kind on the subject.

FAQs

  1. What is Trans-oral total laryngectomy (TOTL) and why is it considered a promising new approach for patients requiring total laryngectomy?
  2. What were the primary complications reported from the studies analyzed in the research paper on TOTL?
  3. How successful was the TOTL procedure in removing all cancerous tissue from patients with LSCC according to the study?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about laryngectomy is to follow post-operative care instructions carefully to help prevent complications such as fistula, bleeding, and stomal stenosis. It is also essential to attend all follow-up appointments to monitor for any signs of disease recurrence. Additionally, patients should communicate any concerns or changes in symptoms to their healthcare provider promptly.

Suitable For

Patients who are typically recommended for laryngectomy include those with:

  1. Laryngeal squamous cell carcinoma (LSCC) or other types of throat cancer that have not responded to other treatments.
  2. Advanced stage laryngeal cancer that has spread beyond the larynx.
  3. Recurrent or persistent laryngeal cancer.
  4. Severe laryngeal trauma or injury.
  5. Severe laryngeal stenosis (narrowing) that cannot be treated with other methods.
  6. Severe laryngeal dysfunction that affects breathing or swallowing.

It is important for patients to consult with their healthcare provider to determine if laryngectomy is the most appropriate treatment option for their specific condition.

Timeline

Before laryngectomy:

  • Patient may experience symptoms such as hoarseness, difficulty breathing or swallowing, and persistent coughing
  • Patient undergoes diagnostic tests such as imaging scans, biopsies, and blood tests to confirm the diagnosis of laryngeal cancer
  • Patient may undergo radiation therapy, chemotherapy, or a combination of both to shrink the tumor before surgery
  • Patient meets with a multidisciplinary team of healthcare professionals to discuss treatment options and prepare for surgery

After laryngectomy:

  • Patient undergoes surgery to remove the larynx, usually performed under general anesthesia
  • Patient may stay in the hospital for a few days to recover from surgery and receive postoperative care
  • Patient may require a tracheostomy (a surgical opening in the neck to help with breathing) and a feeding tube for nutrition
  • Patient undergoes speech therapy to learn how to communicate without a voice box, using methods such as esophageal speech, electrolarynx, or tracheoesophageal puncture (TEP)
  • Patient may experience physical and emotional challenges adjusting to life without a voice box, including changes in appearance, swallowing difficulties, and social isolation
  • Patient requires ongoing follow-up care with healthcare providers to monitor for complications, manage side effects, and support their rehabilitation and recovery journey.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a laryngectomy procedure, specifically TOTL?

  2. How does TOTL compare to traditional methods of laryngectomy in terms of outcomes and recovery time?

  3. Will I still be able to speak after a laryngectomy, and if not, what are my options for communication?

  4. What type of follow-up care will be required after the laryngectomy procedure?

  5. How will the removal of my voice box affect my quality of life and daily activities?

  6. Are there any alternative treatments or procedures that I should consider before undergoing a laryngectomy?

  7. How experienced is the medical team in performing TOTL procedures, and what is their success rate with this technique?

  8. Will I need any additional treatments, such as radiation or chemotherapy, after the laryngectomy?

  9. How long is the recovery period after a laryngectomy, and what can I expect in terms of pain management and rehabilitation?

  10. Are there any long-term side effects or complications that I should be aware of following a laryngectomy?

Reference

Authors: Tumlin P, Dugan B, Hassid S, Lawson G, Turner M. Journal: J Robot Surg. 2024 May 17;18(1):214. doi: 10.1007/s11701-024-01970-2. PMID: 38758418