Subtotal supracricoid laryngectomy: changing in indications, surgical techniques and use of new surgical devices

Abstract Purpose The aim of this study is to evaluate the evolution of supracricoid partial laryngectomy (SCPL) in indications, surgical techniques and outcomes through last decades. Materials and methods A retrospective analysis of 146 patients affected by laryngeal cancer treated with SCPL was carried on. We defined: (1) group A, 100 patients treated by cold instruments between 1995 and 2004; (2) group B, 46 patients treated by harmonic scalpel between 2005 and 2010. Complications rate, and functional and oncological results were documented and a comparison between the two groups was made; histopathological analysis of surgical margins was evaluated and correlated with local incidence of recurrence. Results Significant differences in age mean-value ( p = 0.02), T classification ( p = 0.007), and in indication for more advanced-staged patients were found in group B ( p = 0.001). Surgical procedure was shorter in group B ( p < 0.001), with shorter swallowing recovery ( p = 0.003). Oncological outcomes did not report any significant differences. Group B showed a higher incidence of post- operative arytenoid edema ( p = 0.03) associated with a lower rate of pneumonia ( p = 0.038). Despite a higher rate of close or positive-margins found in group B no higher incidence of local-recurrence was reported ( p = 0.02) compared to group A. Conclusions We documented changing in indications and surgical technique for SCPL because of the development of modern diagnostic techniques and the introduction of low-thermal injury device allowing a more challenging tumor excision as well as with a shorter swallowing recovery in our series.