Functional outcomes after different types of transoral supraglottic laryngectomy

To seek a correlation between the four types of transoral supraglottic laryngectomies (TSLs) according to the European Laryngological Society (ELS) and postoperative morbidity.

Retrospective case series at an academic institution.

Chart review was done for 96 patients affected by T1-T3 supraglottic cancers (28 pT1, 46 pT2, 22 pT3) treated by TSL (29 type I, 14 type II, 35 type III, 18 type IV) with CO2 laser. Five-year overall survival (OS), disease-specific survival (DSS), local control with laser alone (LCL), and organ preservation (OP) were calculated by Kaplan-Meier curves. Thirty-six patients were submitted to swallowing evaluation by M. D. Anderson Dysphagia Inventory (MDADI), videoendoscopy of swallow (VEES), and videofluoroscopy (VFS). Hospitalization, tracheotomy, nasogastric feeding tube (NGFT), and complications were compared between type I-II versus III-IV TSLs for the entire series. MDADI and VEES/VFS scores were compared in the subgroup of 36 patients.

Five-year OS, DSS, LCL, and OP rates were 69%, 85.9%, 89.2%, and 92.6%. Mean hospitalization was 9 days, tracheotomy was required in 7% of patients, an NGFT was required in 33%, and 11% experienced complications. Type III-IV TSLs were associated with increased hospitalization (P < .001), more NGFTs (P = .001), and 90% of complications (P = .021). Aspiration was seen in 0% and 9% of type I-II TSLs, and in 7% and 43% of type III-IV TSLs by VEES and VFS, respectively.

Type III-IV TSLs present higher morbidity and complications, thus confirming the utility of the ELS classification in preoperative counseling and therapeutic planning.

4 Laryngoscope, 126:1131-1135, 2016.