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Published on: March 18, 2020
Functional and oncological outcomes after open partial horizontal laryngectomy: A comparative analysis of
Lucrezia Spadera1, Pietro De Luca2, Vincenzo Della Peruta3
1Department of Otolaryngology-Head and Neck Surgery, Ospedale del Mare Hospital, ASL Napoli Centro, Naples, Italy.
Objective:
This study aimed to evaluate and compare the functional and oncological outcomes of different Open Partial Horizontal Laryngectomy (OPHL) techniques, particularly focusing on the time required for swallowing recovery and the functional impact of preserved laryngeal structures.
Methods:
We performed a retrospective analysis of 92 patients with primary or recurrent laryngeal squamous cell carcinoma treated with OPHL Type I, II, or III between September 2018 and March 2023. Patients were categorized by surgical type (OPHL I, OPHL IIa/CHEP, OPHL IIb/CHP, OPHL IIIa/THEP). Primary endpoints included the time (in days) to tracheostomy cannula removal, phonation onset, swallowing recovery, and Nasogastric Tube (NGT) removal. We also assessed the functional role of epiglottis preservation and arytenoid preservation (±ARY/CAU). Statistical analysis used ANOVA or the Mann-Whitney test, with 5-year Laryngo-Esophageal Dysfunction-Free Survival (LEDFS) calculated by the Kaplan-Meier method.
Results:
Ninety-two patients were included (73 M, 19 F; mean age 63.5 ± 8.1 years). The most common procedures were OPHL IIa (53.3%) and OPHL I (41.3%). Overall, 91 patients (99.0%) were decannulated with a mean time of 6.6 ± 6.9 days. The mean time to swallowing recovery was 12.3 ± 8.3 days, and mean NGT removal was 16.9 ± 9.2 days. Comparative analysis showed that patients undergoing OPHL IIa had significantly earlier recovery outcomes compared to OPHL I: decannulation/pronunciation (p = 0.0087), swallowing recovery (p = 0.0000), and NGT removal (p = 0.0283). Furthermore, OPHL II patients preserving both arytenoids showed a significantly faster recovery of swallowing ability compared to those with arytenoid sacrifice (p = 0.038). Clinically, OPHL IIa was associated with a shorter length of hospital stay than OPHL I (p = 0.0081). The overall 5-year disease-specific survival was 91.3%. The 5-year LEDFS was 86.0% and did not differ significantly between OPHL I and OPHL II (p > 0.05).
Conclusions:
OPHL techniques provide effective oncological control and good functional preservation for selected intermediate and advanced laryngeal carcinomas. OPHL IIa showed superior speed of functional recovery compared to OPHL I, emphasizing the importance of preserving the epiglottis and the complexity of the reconstructive pexy. Preserving both arytenoids significantly enhances early swallowing recovery in OPHL II.
