Feasibility of subtotal laryngectomy based on whole-organ examination

Subtotal (near-total) laryngectomy has recently been advocated to eradicate large laryngeal tumors. The operation, which preserves the cricoarytenoid joint and adjacent vocal fold, is based on the premise that many T3 and T4 tumors can be resected without complete sacrifice of the phonatory mechanism. The purpose of this study was to verify or disprove the assumption by examining sections of whole-organ laryngeal specimens. Twenty-four of the 64 specimens analyzed were determined to be resectable by subtotal laryngectomy. Twenty-two other specimens could have been resected by a more conventional conservation technique such as hemilaryngectomy or supraglottic laryngectomy. This study supports the concept of subtotal laryngectomy for selected large tumors. Guidelines for determining the suitability of the technique are suggested.