Partial Laryngeal Surgery in 2023

Open partial horizontal laryngectomies (OPHLs) have emerged as a pivotal strategy in the conservative treatment of intermediate to advanced stages of laryngeal cancer (LC). This review evaluates the evolution of surgical approaches, focusing on maintaining laryngeal function while ensuring oncological safety. Initially, total laryngectomy dominated the therapeutic landscape, prioritizing tumor control over organ preservation. However, with advancements in understanding LC’s natural history, patient selection and surgical techniques, there has been a paradigm shift towards organ-preserving surgical options like OPHLs. Modern OPHL techniques, backed by enhanced endoscopic and radiological assessments, allow for precise tumor assessment and surgical planning, increasing the likelihood of preserving crucial laryngeal functions such as speech and swallowing. High-definition videolaryngoscopy and magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) have improved the accuracy of pre-operative work-up, thereby refining patient eligibility for partial laryngectomy. The integration of modular surgical approaches and the adoption of new classification by the European Laryngological Society (ELS) further support the versatility of OPHLs in addressing diverse tumor localizations and extents. The review underscores the competitive oncological outcomes of OPHLs compared to non-surgical organ-preservation protocols, highlighting the significant rates of laryngectomy-free survival and the maintenance of laryngeal function. Despite these advances, the treatment of advanced LC remains challenging due to the complex nature of tumor biology and the critical need for precise clinical and pathological assessments. The necessity for a multidisciplinary approach in treatment planning is emphasized to balance oncological control with functional preservation effectively. In conclusion, OPHLs represent a robust option in the current armamentarium for treatment of LC, providing a substantial foundation for enhancing both patient survival and quality of life. The strategic integration of surgical innovations and comprehensive pre-operative assessments is crucial in optimizing treatment outcomes and advancing the field of laryngeal preservation.