Risk of Long-Term Airway Sequelae and Mortality in Laryngeal Chondrosarcoma

In low- and intermediate-grade laryngeal chondrosarcomas, nonradical surgery or even debulking is considered justifiable to preserve laryngeal function. However, tumor- and treatment-related factors affecting the need for reoperation and long-term risk for tracheostomy remain unclear.

We retrospectively analyzed 20 patients with laryngeal chondrosarcoma, treated at the Helsinki University Hospital (Helsinki, Finland) between 2000 and 2023.

In total, four of 20 (20%) patients primarily underwent total laryngectomy. Sixteen of 20 (80%) patients primarily underwent either open partial laryngectomy or endoscopic debulking. In patients with cricoid cartilage tumors primarily treated with larynx-preserving surgery, reoperation due to tumor recurrence or growth (p = 0.003) and transformation from well or moderately differentiated to poorly differentiated or dedifferentiated histology (p = 0.027) were significantly associated with permanent tracheostomy. Two patients presented with distant metastases and two died of laryngeal chondrosarcoma.

Patients primarily presenting with low- or intermediate-grade chondrosarcomas may develop higher-grade local recurrence and distant metastases. Due to paradigm shift from radical to function-preserving surgery in laryngeal chondrosarcoma, guidelines are needed for both primary tumor assessment and postoperative surveillance. To minimize the risk of long-term dysfunction and mortality, early detection of unfavorable tumor histology or rapid growth requiring more aggressive treatment is mandatory.