Total laryngectomy for laryngeal cancer 150 years after its first description: A boon more than a calamity: A STROBE analysis

Eur Ann Otorhinolaryngol Head Neck Dis. 2023 Jan;140(1):25-29. doi: 10.1016/j.anorl.2022.09.001. Epub 2022 Oct 6.

Abstract

Objective: To illustrate the boon rather than a calamity that total laryngectomy can be for a patient with laryngeal cancer in the 21st century.

Material and method: An observational retrospective analysis using the STROBE guideline compared two cohorts of patients with previously untreated cancer, managed by total laryngectomy: the first consisting of 123 patients collected by Morell Mackenzie during the fifteen years (1873-1887) following the initial description, and the second consisting of 53 patients consecutively treated in a French university otorhinolaryngology department during the fifteen years (2006-2020) preceding the 150th anniversary of the first performance. The main endpoint was the comparison of survival and locoregional control estimates (Kaplan-Meier life table method). Secondary endpoints comprised mortality estimates and causes, adjuvant treatments, and phonation modalities.

Results: The 26.2%, 13.1%, and 13.1% 1-, 3-, and 5-year actuarial survival estimates in the Makenzie cohort increased to 88.6%, 68.4%, and 60.9% in the recent French cohort (P<0.0001). The 50.1%, 40.4%, and 34.7% 1-, 3-, and 5-year actuarial locoregional control estimates in the Mackenzie cohort increased to 83.7% (P<0.0001). The 77.7% overall mortality in the Mackenzie cohort decreased to 37.7% (P<.0001). In the Mackenzie cohort, 97.8% of deaths were related to postoperative complications and locoregional recurrence, compared to 50% in the recent French cohort. Distant metastasis, metachronous second primary tumor and intercurrent diseases, not mentioned in the Mackenzie cohort, generated 45% of deaths in the French cohort. Adjunctive treatment was not used in the Mackenzie cohort, whereas neck dissection and postoperative radiation therapy were associated in respectively 98.1% and 69.8% of cases in the French cohort. Phonation was not documented in the Mackenzie cohort; 50% of survivors in the French cohort used a phonatory implant.

Conclusions: The 20th century witnessed an incredible turn-around. Total laryngectomy, with limited indications, has transformed the etiology of deaths and no longer leaves patients "in a state of abject misery" as Morell Mackenzie put it in 1888.

Keywords: Cancer; Larynx; Total laryngectomy.

Publication types

  • Observational Study

MeSH terms

  • Carcinoma, Squamous Cell* / pathology
  • Humans
  • Laryngeal Neoplasms* / pathology
  • Laryngectomy / methods
  • Neoplasm Recurrence, Local / pathology
  • Retrospective Studies
  • Treatment Outcome