Total Laryngectomy

Total laryngectomy is a well-established and standardised surgical technique for the surgical treatment of advanced laryngeal tumours. Combined with unilateral or bilateral neck dissection and post-operative (chemo-)radiotherapy, it still is the standard of care for locally advanced tumours of the larynx or hypopharynx that are not suitable for open or endoscopic partial laryngectomy. In patients with hypopharyngeal or subglottic primary tumours, unilateral or subtotal thyroid gland and paratracheal node resection may be necessary. Salvage total laryngectomy has a very important role in nonsurgical organ-preservation protocols. Prior to surgery, the patient must understand the indication for surgery, possible complications and sequelae and lifestyle modifications after surgery. A thorough preoperative assessment is required prior to discussing the indication for total laryngectomy. This will generally include a general medical assessment, pulmonary function tests, CT or MRI scanning of the neck and CT scanning of the lung (or PET-CT) to rule out distant metastasis. Two main ways to remove the larynx are generally used: above-downward approach or below-upward approach. For every tumour, the surgeon must analyse the best way to remove the larynx. Frozen sections of surgical margins should be obtained before closure of the pharynx. There are many different ways to reconstruct the pharynx. Surgeons should be familiar with primary closure of the defect and free flap reconstruction.