CONSERVATION SURGERY OF THE LARYNX - REAPPRAISAL BASED ON WHOLE ORGAN STUDY

A series of 103 patients undergoing total laryngectomy and serial whole larynx examination between 1954 and 1966 at The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute was studied retrospectively. Six patients with supraglottic carcinomas and five patients with glottic carcinomas would have been candidates for partial laryngectomy on the basis of clinical and radiologic evaluations. A careful examination of the histopathologic specimens of these 11 patients reconfirmed the embryologic and compartmentalization principles on which conservation laryngeal surgery is formulated. In addition, three areas that must be critically assessed by intraoperative frozen section examination whenever a partial laryngectomy is performed were demonstrated: the anterior commissure, the subglottis, and the paraglottic space. Involvement of the anterior commissure by tumor makes invasion of the thyroid cartilage or extension into the cricothyroid membrane possible. Carcinomas originating on the true vocal cords are more prone to such involvement than are supraglottic tumors due to the embryologic barriers of the larynx. Anterior subglottic extension of tumor allows access to lymphatic channels by way of the cricothyroid membrane. The paraglottic space is entered during a supraglottic laryngectomy; the microscopic presence of tumor in the space inferior to the level of resection, particularly lateral to the true cord and the arytenoid, must be considered. Our experience has shown that laryngeal tomography and laryngography accurately define these critical areas preoperatively and are essential to an adequate total evaluation of the patient's tumor. Frozen section examination of these areas at the time of direct laryngoscopy and partial laryngectomy is mandatory. In those cases in which microscopic residual carcinoma remains or the disease-free margin of resection is close, an intraoperative decision regarding extension of the partial procedure, conversion to total laryngectomy, or planned postoperative radiation can be intelligently made. Good local control of disease can be expected with such an approach. © 1979.