Cancer spread in the larynx: A pathologic basis for conservation surgery

Background Previous pathologic studies of the spread of laryngeal carcinoma have drawn inferences about the site of origin of tumors, their mechanisms of growth, or the role of structures as potential barriers to tumor spread. Most of the information is based on the study of advanced or recurrent tumors and is difficult to apply to conservation surgical technique. We carried out a systematic analysis of a wide range of laryngeal tumors with the aim of providing a basis for conservation surgery. Methods We analyzed tumor invasion of the laryngeal spaces and the laryngeal framework in relation to the mucosal tumor extent by axial sectioning of 80 sequential partial and total laryngectomy specimens. Results Invasion of a particular laryngeal space could be accurately predicted by mucosal tumor extent and vocal cord mobility. Invasion of the laryngeal framework was associated with tumor extension to the ventricle, subglottis, or pyriform fossa. The thyroid cartilage and the cricothyroid space and ligament were the most frequent sites of invasion. Conclusions The mucosal distribution of a tumor and observation of vocal cord mobility can be used to determine accurately the extent of tumor invasion of the laryngeal spaces and framework and therefore the extent of resection necessary. © 2000 John Wiley & Sons, Inc. Head Neck 22: 265–274, 2000.