Total Laryngectomy for Treatment of T4 Laryngeal Cancer: Trends and Survival Outcomes

Abstract

Introduction: Management of advanced laryngeal cancer has shown fluctuating trends during the last few decades. Though many extensive reports are available in the literature regarding survival outcomes for advanced laryngeal cancer, there is a paucity of elaborate systematic reviews giving a complete picture of facts and figures. The present analysis brings to attention the most relevant data in a focused and up to date format, for simpler interpretation of evidence-based inference. Objective: To present the trends in the treatment of T4 laryngeal cancer over the past few decades and analyze survival outcomes for different treatment modalities in the management of T4 laryngeal cancer by way of systematic review. Methods : An electronic search was conducted using the terms “total laryngectomy”, “T4 laryngeal cancer”, “survival outcomes” in combination with the following search strategy : Search block Laryngeal cancer - "Laryngeal Neoplasms"[Mesh] OR ((Laryngeal[tiab] OR larynx[tiab] OR "Larynx"[Mesh]) AND (“Neoplasms”[Mesh] OR neoplasm* [tiab] OR tumor* [tiab] OR tumour* [tiab] OR cancer* [tiab] OR malignancy* [tiab] OR carcinoma* [tiab] OR neoplasm* [tiab] OR oncology* [tiab])); Search block Total laryngectomy - "Laryngectomy"[Mesh] OR total laryngectomy*[tiab] OR total laryngopharyngectomy*[tiab] OR total pharyngolaryngectomy*[tiab]; Search block T4 - t4[tiab]. Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, SCOPUS and Cochrane Library. 304 articles had been published till June 2017, which included prospective studies, randomized controlled trials, retrospective studies, and smaller descriptive studies. References of the selected studies were further searched for relevant articles. Apart from this, a search was conducted over Google Scholar to obtain related articles. Results: Numerous studies, as mentioned in this review, provide authentic evidence in relation to the efficacy and outcome of surgical treatment for T4 laryngeal cancer. To address the problem of heterogeneity with regards to patient selection, numerous reports pertaining to T4 patients exclusively have been included. Conclusion: Total laryngectomy remains the gold standard for management of T4a laryngeal cancer. After the unparalleled oncological outcomes of more than a century, the technique has stood the test of time. An exhaustive review of the literature has been presented, discussing the trends in the treatment of advanced laryngeal cancer across different continents. However, it must be specified that the purpose of the study is not to prove one treatment protocol to be superior to the other but to bring out patterns of adherence to protocols and guidelines as suggested by multidisciplinary consensus reports and the consequent outcomes.