European Archives of Oto-Rhino-Laryngology

, Volume 269, Issue 6, pp 1635–1646 | Cite as

Subtotal laryngectomy: outcomes of 469 patients and proposal of a comprehensive and simplified classification of surgical procedures



Long-term oncological and functional results from a retrospective study on 469 patients over a 10-year period of subtotal laryngectomies (SL), 399 supracricoid partial laryngectomies (SCL) and 70 supratracheal partial laryngectomies (STL) are presented. The mean follow-up time was 97 months (range 60–165 months). Acute complications, types and rates of late sequelae, functional results, 2-year post-operative scores of laryngeal function and quality of life are reported. The observed long-term results were: SCL, 5-year overall and disease-free survival: 95.6, and 90.9%, respectively; 2-year post-operative laryngeal function preservation: 95.7%; STL, 5-year overall and disease-free survival: 80 and 72.9%, respectively; 2-year post-operative laryngeal function preservation: 80%. The performance status scale for laryngeal function preservation showed very high 2-year scores, with no significant differences depending on the type and extent of surgery. The adopted type of function-sparing surgery provided overall and disease-free survival rates that were somewhat better than those reported in studies based on organ-sparing protocols with chemoradiotherapy. The rate of total laryngectomy of completion in this series was 4.4%. A new classification of the current horizontal partial laryngectomies is also proposed, namely “Horizontal Laryngectomy System” (HOLS), based on the extent of surgical removal of laryngeal structures.


Subtotal laryngectomies Supracricoid partial laryngectomies Supratracheal partial laryngectomies Laryngeal function preserving surgical protocol Laryngeal cancer 


  1. 1.
    Ferlay J, Parkin DM, Steliarova-Foucher E (2010) Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 46:765–781PubMedCrossRefGoogle Scholar
  2. 2.
    Serafini I (1972) Reconstructive laryngectomy. Rev Laryngol Otol Rhinol 93:23–32Google Scholar
  3. 3.
    Laudadio P, Presutti L, Dall’Olio D, Cunsolo E, Consalici R, Amorosa L, Cancellieri A, Bocciolini C (2006) Supracricoid laryngectomies: long-term oncological and functional results. Acta Otolaryngol 126(6):640–649PubMedCrossRefGoogle Scholar
  4. 4.
    Laccourreye O, Brasnu D, Biacabe B, Hans S, Seckin S, Weinstein G (1998) Neo-adjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidopexy for advance endolaryngeal carcinoma classified as T3–T4: 5-year oncologic results. Head Neck 20:595–599PubMedCrossRefGoogle Scholar
  5. 5.
    De Vincentiis M, Minni A, Gallo A, Di Nardo A (1998) Supracricoid partial laryngectomies: oncologic and functional results. Head Neck 20(6):504–509PubMedCrossRefGoogle Scholar
  6. 6.
    Piquet JJ, Desaulty A, Decroix G (1974) La Crico-hyoido-épiglotto-pexie. Tecnique opératoire et résultats fonctionnels. Ann Otolaryngol Chir Cervicofac 91:681–690PubMedGoogle Scholar
  7. 7.
    Labayle S, Bismuth R (1971) La laryngectomie totale avec reconstruction. Ann Otol-laryngol 88:219–228Google Scholar
  8. 8.
    Rizzotto G, Succo G, Lucioni M, Pazzaia T (2006) Subtotal laryngectomy with tracheohyoidopexy: a possible alternative to total laryngectomy. Laryngoscope 116:1907–1917PubMedCrossRefGoogle Scholar
  9. 9.
    Union International Contre le Cancer (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New YorkGoogle Scholar
  10. 10.
    Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 199–205Google Scholar
  11. 11.
    Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT (2002) Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. American Head and Neck Society; American Academy of Otolaryngology—Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 128(7):751–758PubMedGoogle Scholar
  12. 12.
    Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre J, Greiner RH et al (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952PubMedCrossRefGoogle Scholar
  13. 13.
    Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944PubMedCrossRefGoogle Scholar
  14. 14.
    List MA, Ritter-Sterr C, Lansky SB (1990) A Performance Status Scale for head and neck cancer patients. Cancer 66:564–569PubMedCrossRefGoogle Scholar
  15. 15.
    Weir NF (1973) Theodore Billroth: the first laryngectomy for cancer. J Laryngol Otol 87:1162–1170CrossRefGoogle Scholar
  16. 16.
    McLaughlin MP, Parsons JT, Fein DA, Stringer SP, Cassisi NJ, Mendenhall WM, Million RR (1996) Salvage surgery after radiotherapy failure in T1–T2 squamous cell carcinoma of the glottis larynx. Head Neck 18(3):229–235PubMedCrossRefGoogle Scholar
  17. 17.
    Peretti G, Piazza C, Ansarin M, De Benedetto L, Cocco D, Cattaneo A, Nicolai P, Chiesa F (2010) Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas. Eur Arch Otolaryngol 267(11):1735–1742CrossRefGoogle Scholar
  18. 18.
    Ambrosch P (2007) The role of laser microsurgery in the treatment of laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 15(2):82–88PubMedCrossRefGoogle Scholar
  19. 19.
    Steiner W, Ambrosch P, Rodel RM, Kron M (2004) Impact of anterior commissure involvement on local control of early glottis carcinoma treated by laser microresection. Laryngoscope 114(8):1485–1491PubMedCrossRefGoogle Scholar
  20. 20.
    Lefebvre JL, Ang KK et al (2009) Larynx preservation clinical trial design: key issues and recommendations—a consensus panel summary. Head Neck 31:429–441PubMedCrossRefGoogle Scholar
  21. 21.
    Peretti G, Piazza C, Mensi MC, Magnoni L, Bolzoni A (2005) Endoscopic treatment of cT2 glottic carcinoma: prognostic impact of different pT subcategories. Ann Otol Rhinol Laryngol 114(8):579–586PubMedGoogle Scholar
  22. 22.
    de Bree R, Leemans R, Silver CE et al (2011) Paratracheal lymph node dissection in cancer of the larynx, hypopharynx and cervical esophagus: the need of guidelines. Head Neck 33:912–916PubMedCrossRefGoogle Scholar
  23. 23.
    Benito J, Holsinger FC, Perez-Martin A et al (2011) Aspiration after supracricoid partial laryngectomy: incidence, risk factors, management and outcomes. Head Neck 33:679–685PubMedCrossRefGoogle Scholar
  24. 24.
    Spriano G, Pellini R, Romano G, Muscatello L, Roselli R (2002) Supracricoid partial laryngectomy as salvage surgery after radiation failure. Head Neck 24:759–765PubMedCrossRefGoogle Scholar
  25. 25.
    Weinstein SG, Myers EN, Shapshay SM (2004) Nonsurgical treatment of laryngeal cancer. N Eng J Med 350:1049CrossRefGoogle Scholar
  26. 26.
    Hoffman HT, Porter K, Karnell LH, Cooper JS, Weber RS, Langer CJ, Ang KK, Gay G, Stewart A, Robinson RA (2006) Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope 116(9 Pt 2 Suppl 111):1–13PubMedCrossRefGoogle Scholar
  27. 27.
    Remacle M, Eckel HE, Antonelli AR, Brasnu D, Chevalier D, Friedrich G, Olofsson J, Rudert HH, Thumfart W, de Vincentiis M, Wustrow TP (2000) Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol 257(4):227–231PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • G. Rizzotto
    • 1
  • E. Crosetti
    • 2
  • M. Lucioni
    • 1
  • G. Succo
    • 2
    • 3
  1. 1.Department of OtorhinolaryngologyOspedale Civile of Vittorio VenetoBellunoItaly
  2. 2.Department of OtorhinolaryngologyOspedale MartiniTurinItaly
  3. 3.ENT DepartmentOspedale MartiniTorinoItaly

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