Extralaryngeal spread of cancer of the larynx: a study with whole-organ sections

Thirty total laryngectomy and five pharyngolaryngoesophagectomy specimens were studied with the whole-organ sectioning technique. The horizontal plane of sectioning was chosen to study the pattern and degree of extralaryngeal spread in carcinoma of the larynx. There were 22 transglottic, 6 supraglottic, and 7 infraglottic tumors. Among them there were 1 T1, 2 T2, 5 T3, and 27 T4 lesions. Spreading anteriorly, the tumor was found to penetrate the thyrohyoid membrane in 7 (32%) out of 22 transglottic tumors. Among the entire group of 35 specimens the thyroid cartilage was penetrated in 18 cases (51%), and the infrahyoid strap muscles were invaded by tumor in 17 cases (49%). The cricothyroid membrane was penetrated in 19 cases (54%). Spreading posteriorly, the tumor reached or eroded the mucosa of the pyriform fossa in 15 cases (43%), including 10 total laryngectomy specimens. The postcricoid submucosa was involved by tumor in 13 cases (37%) among which 9 were total laryngectomy specimens. It is thus recommended that the wide-field technique should be used for laryngectomy. Awareness of the possibility of tumor reaching the mucosa of the pyriform fossa and the postcricoid area allows the surgeon to keep clear of tumor in performing total laryngectomy.