Digital archive of theses discussed at the University of Pisa


Thesis etd-12022019-223629

Thesis type
Tesi di specializzazione (5 anni)
Thesis title
Open Partial Laryngeal Surgery. Survival outcomes, prognostic factors and neck management: a single institutional analysis
Course of study
relatore Prof. Gallo, Oreste
correlatore Dott. Maggiore, Giandomenico
  • Laryngeal cancer
  • reconstructive laryngeal surgery
  • Open partial laryngeal surgery
Graduation session start date
Release date
Laryngeal cancer represents the fifth to sixth most common malignancy in men in Europe and USA. In 2002, the World Health Organization estimated 600,000 new head and neck cancer cases and 300,000 deaths worldwide and the larynx accounts for approximately 160,000 cases per year, with higher incidence in males (2.5% of all tumours) than in females (0.5%).
Most patients present laryngeal carcinoma in the glottic or supraglottic region, and 55-75% are diagnosed with early cancers, with a favourable prognosis. In these scenario, the goals of the therapy, together with the achievement of a high rate of local control, is a possible preservation of function. Such results can be achieved by different approaches, including primary (or adjuvant) external beam radiotherapy, transoral laser microsurgery (TLM), open partial laryngeal surgery and, more recently, robotic transoral surgery. Each of these modalities has specific advantages and limitations, and the treatment option performed is based on the evaluation of many issues such as tumour extension, need for functional reconstruction, physician technical skill, adequate resources, and ultimately patient choice.
Currently, radiotherapy and TLM appear to be widely used treatment modalities, particularly for early glottic carcinomas, but conservative laryngeal open surgery remains a mainstay against laryngeal cancer in a wide spectrum of patients. During the years, the indication to treat advanced lesions (T3-T4) with conservative approaches is growing. In fact, partial laryngectomies, either by TLM or open approach, not only allow for a radical oncologic control but also permit, through the conservation of a cricoarytenoid unit, the creation of a neolarynx adequate for swallowing as well as for speaking.
It has to be underscored that OPLS must compared total laryngectomy and its oncological results of total laryngectomy and for this reason the optimal balance between survival chances and the avoidance of mutilating surgery remains one of the most challenging tasks for the otolaryngologist.
The aim of the present thesis is to explore the different issues of OPLS in the current management of LC. We analysed our institutional dataset in order to critically discuss oncological outcomes, prognostic factors, postoperative complications and functional sequelae. In addition, we wanted to study the problem of elective neck dissection in this setting given that it appears to be a neglected topic in the literature. We also proposed a practical set of nomograms that can aid to tailor the single patient’s strategy when this peculiar and fascinating surgery becomes an option.