Our Summary

This research paper is about a surgical procedure called total laryngectomy, which is used to treat advanced cases of laryngeal and hypopharyngeal cancer. This procedure removes the entire larynx and is an effective treatment, especially when the cancer has not spread to other parts of the body.

The paper explains that this surgery is often better than using radiation or chemotherapy, especially for patients in the advanced stage of the disease (cT4a). It also highlights that laryngectomy is suggested when the tumor causes dysfunction in the larynx, such as difficulty swallowing or aspiration. It’s also used when cancer comes back after radiation or chemotherapy.

However, after the surgery, patients lose their ability to speak normally. Therefore, they need to undergo voice rehabilitation which might include the use of a voice prosthesis.

The paper details the process of laryngectomy, including how doctors decide if a patient should have the surgery, the steps of the surgery itself, possible complications, other treatment options, and the process of rehabilitation after the surgery. It concludes by stating that total laryngectomy remains a standard procedure in treating advanced head and neck cancers.

FAQs

  1. What are the primary indications for a total laryngectomy?
  2. How does the total laryngectomy procedure compensate for the subsequent loss of voice?
  3. What are the potential complications of a total laryngectomy procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to ensure they participate in voice rehabilitation to help compensate for the loss of voice after the procedure. This can include using a voice prosthesis or learning alternative methods of communication. It is important for patients to work closely with speech therapists and healthcare providers to achieve the best possible outcomes in terms of communication and quality of life post-surgery.

Suitable For

Patients who are typically recommended for laryngectomy include those with advanced laryngeal and hypopharyngeal cancer without distant metastasis, especially in stage cT4a disease. Other indications for the procedure include tumor-related laryngeal dysfunction such as dysphagia and aspiration, as well as cancer recurrence after primary radio(chemo)therapy. Laryngectomy remains a standard procedure in modern head and neck oncology for these patients.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with advanced laryngeal or hypopharyngeal cancer without distant metastasis.
  2. Patient may undergo various diagnostic tests such as imaging studies, biopsy, and PET-CT scan to determine the extent of the cancer.
  3. Treatment options are discussed with the patient, including the possibility of laryngectomy.
  4. Patient may undergo preoperative counseling and preparation for the surgery.

After laryngectomy:

  1. Patient undergoes total laryngectomy surgery to remove the larynx and surrounding structures affected by cancer.
  2. Patient may experience temporary or permanent loss of voice due to the surgery.
  3. Patient undergoes voice rehabilitation to learn new ways of speaking, such as with a voice prosthesis or ructus.
  4. Patient may experience complications such as difficulty swallowing, changes in taste, and psychological issues related to the surgery.
  5. Patient undergoes follow-up care and monitoring for cancer recurrence.
  6. Prognosis and long-term outcomes are discussed with the patient, including the potential for a cure and quality of life post-surgery.

What to Ask Your Doctor

  1. What are the indications for a laryngectomy in my case?
  2. What alternative treatment options are available for my condition?
  3. What are the potential risks and complications associated with a laryngectomy?
  4. How long is the recovery process after a laryngectomy?
  5. What support systems are available for patients undergoing a laryngectomy, such as speech therapy or support groups?
  6. What is the prognosis for patients who undergo a laryngectomy?
  7. How will my ability to speak and swallow be affected by the surgery?
  8. Will I be able to continue working or engaging in my usual activities after a laryngectomy?
  9. What follow-up care will be needed after the surgery?
  10. Are there any lifestyle changes or accommodations that I will need to make post-surgery?

Reference

Authors: Vahl JM, Schuler PJ, Greve J, Laban S, Knopf A, Hoffmann TK. Journal: HNO. 2019 Dec;67(12):955-976. doi: 10.1007/s00106-019-00769-0. PMID: 31720696