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Related Experiment Videos

Near-total laryngectomy.

Sultan A Pradhan1, Anil K D'Cruz, Prathamesh S Pai

  • 1Head and Neck Services, Tata Memorial Hospital, Parel, Mumbai, India. npradhan@vsnl.com

Asian Journal of Surgery
|June 26, 2007
PubMed
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Near-total laryngectomy (NTL) offers oncologically safe, voice-preserving surgery for advanced laryngeal and pharyngeal cancers. This method creates a maintenance-free biological shunt, yielding superior voice quality compared to prosthetic shunts.

Area of Science:

  • Otolaryngology
  • Surgical Oncology
  • Speech Pathology

Background:

  • Advanced laryngeal and pharyngeal cancers often require extensive surgical resection.
  • Voice conservation is a critical aspect of post-treatment quality of life.
  • Traditional laryngectomy with prosthetic shunts presents challenges in maintenance and voice quality.

Purpose of the Study:

  • To evaluate the oncological and physiological safety of near-total laryngectomy (NTL).
  • To assess NTL's efficacy in voice conservation, especially after pharyngoplasty or in post-radiation recurrences.
  • To compare the voice outcomes of NTL's biological shunt with tracheo-esophageal puncture (TEP) prosthetic shunts.

Main Methods:

  • A study of 150 patients with laryngeal (52) or pyriform fossa (98) cancers undergoing NTL.

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  • Analysis included advanced stage (T3/T4) and node-positive patients, with some requiring pharyngoplasty or salvage after radiation.
  • Voice analysis compared NTL (39 patients) with TEP prosthesis (41 patients) using acoustic characteristics.

    • Main Results:

    • 72.7% of patients were alive and disease-free at a median follow-up of 38 months.
    • 90% achieved communicable speech with NTL, including 100% success in 12 cases with extended pharyngoplasty.
    • NTL resulted in significantly better voice parameters (fundamental frequency, range, maximum frequency) compared to TEP, with fewer complications.

    Conclusions:

    • NTL is an oncologically safe and effective voice conservation procedure for advanced laryngeal and pyriform fossa cancers.
    • It provides a maintenance-free biological shunt with superior, near-normal voice quality compared to prosthetic shunts.
    • NTL should be considered for advanced malignancies where feasible, offering a lifetime of independent speech.