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Laryngeal squamous cell carcinoma is one of the most common head and neck cancer, and it occurs more commonly in men than in women. The thought of losing phonatory and swallowing function has become the driving force of advancements in laryngeal cancer treatment.Transoral robotic surgery (TORS) is one of the fastest growing areas of head and neck surgery. This technology is assisted by remote-controlled miniaturized surgical instruments and magnified visualization with a high-definition three-dimensional camera. TORS is increasingly being used and was described in the context of laryngeal cancer surgery. It has been explored as minimally invasive surgery for supraglottic and glottic lesions, as well as for total laryngectomy. Transoral organ-preserving approaches have shown favorable oncologic and functional outcomes with good quality of life. Rapidly advancing TORS technique affords surgeons exceptional views of the larynx and hypopharynx with facile maneuverability in difficult to access areas. Thus, achieving negative margins and preserving normal laryngeal structures has become increasingly possible. The use of the robot for laryngeal cancer falls into three main categories: supraglottic laryngectomy, total laryngectomy and glottic cordectomy. Transoral robotic surgery for laryngeal cancer has been shown to be feasible for minimally invasive partial laryngectomy for either supraglottic or glottic cancer, as well as for total laryngectomy, in selected patients. TORS supraglottic laryngectomy and TORS total laryngectomy have demonstrated good functional and oncologic outcomes.

Introduction and purpose: The laryngeal cancer is the most common cancer of head and neck and is associated with smoking. It is mainly squamous cell carcinoma. There are many methods to diagnosis this cancer. The most important method of the treatment is complicated operation – laryngectomy which is described in this article. There are presented diagnosis and staging of laryngeal cancer, the main types of laryngectomy, process, results and complications. And the end of this article will be mentioned about the loss of voice and of normal and efficient verbal communication as a negative consequence associated with this type of surgery that can have significant impacts on the quality of life. The purpose of this article is to familiarize readers with the topic of laryngectomy as the primary treatment for larynx cancer.Description of the state of knowledge: Studies show an increase in the incidence of this type of cancer. The main risk factors are smoking, drinking alcohol and exposure to heavy metals. Symptoms are really different and include hoarseness, sore throat, coughing and dysphagia. Depending on the location, the course of the cancer can be different. The main examinations are laryngoscopy, CT, MRI, USG and PET. The laryngectomy procedure as a main therapy must be radical as far as possible to the extent that the tumor can be resected within healthy tissue but the goal is to preserve the largest possible function of the organ. The most often complication is pharyngocutaneous fistula.Summary: The laryngectomy is the main method of therapy of the laryngeal cancer. it is a mutilating and often speech-depriving procedure but medicine has now many solutions for this kind of patients.

Introduction: Laryngeal cancer is one of the most common type of head and neck cancers. It develops due to spontaneous mutation or influence of external factors (physical, biological and chemical). Cigarette smoking is primary chemical risk factor of laryngeal cancers. Purpose: The aim of the review was to present a role of tobacco smoking in the causation of laryngeal cancer. State of knowledge: Many of studies performed past years confirmed the correlation between tobacco addiction and head and neck cancers. 75% of all head and neck cancers are caused by cigarette smoking, which contains thousands of chemicals. More than 60 of them are known as carcinogens. Summary: Laryngeal cancer is the most common head and neck cancer. The prevalence of laryngeal cancer is increased by several carcinogens including tobacco smoking, which is known as the major risk factor of this type of cancers.

Introduction: The use of a carbon dioxide (CO2) laser combined with a microscope has revolutionized the surgical approach in treating larynx lesions. This method is mainly used in malignant and premalignant lesions in the larynx. The CO2 laser is also commonly used to widen the glottis and in palliative surgery. Aim of study: The purpose of our study was to show advantages and disadvantages of using a CO2 laser in surgery for laryngeal cancer while analyzing available literature. Material and methods: An unsystematic review of Polish and English-language scientific literature was carried out. Electronic databases: SCOPUS, Google Scholar and PubMed were searched using keywords: laser surgery, CO2 laser, laryngeal cancer, larynx. Description of the state of knowledge: CO2 laser microsurgery is characterized by precision and a high safety profile. Low tracheotomy rate, preservation of the closed anatomical area of the neck, makes the operation lightly burdening, shortens the time of hospitalization and recovery. Moreover, it minimizes costs and has a positive impact on the quality of life. The disadvantages of using a CO2 laser mainly relate to transient perioperative and postoperative complications. Disturbances in voice emission clearly have a negative impact on functioning in society. The use of a carbon dioxide laser in the presence of anesthetic gases creates the risk of ignition in the respiratory tract, tissue burns or attachment of the endotracheal tube. Conclusions: The use of a CO2 laser in the treatment of larynx lesions has advantages and disadvantages. The benefits of this technique outweigh the rare complications. Side effects are usually minor and transient but may lead to damage to health. It is worth remembering that only early neoplastic lesions are operated with the CO2 laser, which emphasizes the essence of prevention. Key words: laser surgery; CO2 laser; laryngeal cancer; larynx

Este estudo levantou a presença de sintomas subjetivos de fadiga nos pacientes laringectomizados. Utilizamos o instrumento proposto por YOSHITAKE27 que investiga os sintomas de mal-estar, cansaço mental e sensações específicas de cansaço. Os dados foram confrontados com a literatura e demonstraram que os fatores psicológicos, o tratamento e a fase da doença estão diretamente relacionados.Este estudio observó la presencia de síntomas subjetivos de fatiga en pacientes laringectomizados. Utilizamos el instrumento propuesto por YOSHITAKE27 que investiga los síntomas de malestar, cansancio mental y sensaciones específicas de cansancio. Los datos fueron confrontados con la literatura, demostrando que los factores psicológicos, el tratamiento y la fase de la enfermedad están directamente relacionadas.This study searched for subjective elements in the fatigue of laryngectomized patients. The authors used an instrument proposed by YOSHITAKE27 that investigates the symptoms of physical indisposition, mental weariness and a specific sensation of fatigue. Data were analysed considering the literature, demonstrating that the psychological factors, the treatment and phases of the disease are directly related.

Introduction and Objectives: Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival., Methods: The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death., Results: The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P=.000) and between fistula and infection (P=.000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P=.038), T4 (P=.026), lymphovascular invasion (P=.019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P=.005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P=.026)., Conclusions: Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery., (Copyright © 2020 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Total laryngectomy is one of the most mutilating oncological operations. There are no specific studies evaluating return to work after this surgery., Patients and Methods: A cross-sectional study was performed on a sample of 116 laryngectomized patients who were disease- free and had a minimum follow-up of 2 years from total laryngectomy. A survey was conducted to find out their employment situation before and after surgery. At the time of surgery, 62 (53%) were working, 40 (35%) were retired and 14 (12%) were in a disability situation., Results: 60% had professions with low qualification requirements, the largest group being construction workers. Of the 62 patients active at the time of total laryngectomy, 29 became inactive and 33 (53%) maintained their work activity. The most important factors in maintaining work activity were the level of professional qualification and the method of vocal rehabilitation. Eighty percent of the patients with high-intermediate qualification maintained their jobs, compared to 35% of those with low professional qualifications (P<.001). Seventy percent of the patients with voice prostheses maintained their work activity, compared to 31% of the patients rehabilitated with oesophageal voice (P=.004). Logistic regression confirmed these as independent variables for continuing to work., Conclusions: This is the first study that analyzes the impact of total laryngectomy on the work situation. The most important factors for a return to work were having a high-intermediate skilled job and the use of voice prosthesis as a method of vocal rehabilitation., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Introduction and Objectives: Interventional endoscopy allows us to act on the pathology of the patient with minimal discomfort, low costs and high efficiency. We assessed the validity of flexible endoscopic biopsies in our hospital, in lesions suspected of malignancy in the rhino-pharyngo-laryngeal space., Subjects and Methods: Retrospective study of patients with a pathology suspected of malignancy assessed between 2006-2016 in our centre. We evaluated the effectiveness, the tolerance and the number of complications. We calculated the cost reduction in comparison with direct laryngoscopy in the operating room. We compared our sample with others of similar characteristics described in the literature., Results: Thirty patients were studied with a flexible endoscopic biopsy during that period. Nineteen patients obtained positive results which allowed them to start treatment for their pathology. Seven cases had no evidence of malignancy and required another biopsy under general anaesthesia, which confirmed the carcinoma diagnosis. Two samples ruled out malignancy which was confirmed by laryngeal microsurgery. One case showed inflammation and the lesion was cured after antibiotherapy. It was impossible to collect the sample in one case. Thus, we obtained sensitivity levels of 73% with a specificity of 100%. There were no complications. The cost reduction in our sample was above 80%., Conclusions: Flexible endoscopic biopsy has advantages over direct laryngoscopy that are relevant in the diagnosis of oncological pathology in otorhinolaryngology., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Antecedentes: El cáncer de laringe representa el 21.7% de las neoplasias malignas de vías aerodigestivas superiores. La prevalencia del virus del papiloma humano (VPH) en el cáncer de laringe oscila entre el 0 y el 80%., Método: Se incluyeron 112 muestras de tejido laríngeo de pacientes con cáncer de laringe. Se amplificó el ADN y se analizó la presencia y el genotipo del VPH mediante hibridación reversa (INNO-LiPA ® ). Se realizaron pruebas de ji cuadrada, Fisher y t de Student no pareada., Resultados: Se incluyeron muestras de 107 hombres (95.5%) y 5 mujeres (4.5%), con una edad de 65.3 ± 10.1 años, con antecedente de tabaquismo 108 (96.4%), alcoholismo 9 (8.0%) y carcinoma epidermoide moderadamente diferenciado queratinizante 96 (85.7%). Se identificó VPH en 60 (53.5%), VPH-11 en 51 (45.5%), VPH-52 en 27 (24.1%), VPH-16 en 9 (8.0%), VPH-45 en 3 (2.6%) y coinfección por más de un genotipo en 31 (27.6%). No hubo diferencia entre pacientes con y sin infección por VPH en cuanto a edad, sexo, localización, diagnóstico histopatológico, tabaquismo ni alcoholismo (p > 0.05)., Conclusiones: La prevalencia de infección por VPH en el cáncer de laringe fue del 53.5%, con coinfección por más de un genotipo en el 27.6%. El genotipo más frecuente fue el VPH-11, tipo de bajo riesgo, seguido por el VPH-52, de alto riesgo oncogénico., Background: Laryngeal cancer represents 21.7% of malignancies of the upper aerodigestive tract. The prevalence of the Human Papillomavirus (HPV) in laryngeal cancer ranges 0 to 80%., Methods: We included 112 laryngeal tissue samples obtained from patients with laryngeal cancer. DNA was extracted and amplified by PCR. HPV presence and genotype were analyzed by the reverse hybridization INNO-LiPA ® assay. Chi-square, Fisher’s and unpaired Student t tests were used., Results: Samples from 107 male (95.5%) and 5 female patients (4.5%) were evaluated, aged 65.3±10.1 years, 108 with smoking history (96.4%), 9 with alcoholism history (8.0%), and in 96 the histological diagnosis was moderately differentiated keratinizing squamous cell carcinoma (85.7%). HPV was detected in 60 samples (53.5%), HPV-11 in 51 (45.5%), HPV-52 in 27 (24.1%), HPV-16 in 9 (8.0%), HPV-45 in 3 (2.6%), and coinfection by more than one genotype in 31 (27.6%). There was no difference between patients with and without HPV infection with respect to age, sex, tumor location and histology, smoking and alcoholism history (p>0.05)., Conclusions: The prevalence of HPV infection in laryngeal cancer was 53.5% with coinfection with more than one genotype in 27.6%. The most frequent genotype was HPV-11, an oncogenic low-risk genotype, followed by HPV-52, a high-risk genotype., (Copyright: © 2018 Permanyer.)

Background: The standard of care for advanced-stage laryngeal cancer is combined treatment (chemo-radiotherapy). However, the complications with this treatment are not few, mainly in swallowing. Conservative laryngeal surgery remains an effective alternative for cancer control without the complications of chemo-radiotherapy., Material and Methods: Retrospective study was conducted on patients with laryngeal cancer cT3, cN0 with paraglottic infiltration, fixation of the vocal cord, minimal invasion of the hyo-thyroepiglottic space, but with normal arytenoid mobility and no sub-glottic extension, were treated with subtotal supracricoid laryngectomy. Complications, sequels of treatment, and local recurrence were evaluated. Bronchial aspiration was studied with radioactive swallow., Results: There were 25 patients, 22 with negative surgical margins, one had tumour contact with the surgical margins, and 2 were positive. Two patients received postoperative radiotherapy. The mean decannulation was 15 days and removal of nasogastric tube 25 days. During the mean follow-up of 26 months, none of the patients had tumour recurrence or required conversion to total laryngectomy. In all patients swallowing has been normal and none required permanent or temporary tracheotomy or definitive gastrostomy. The voice is considered intelligible in all patients. Radioactive swallow showed aspiration in 15/25 patients, with none being clinically relevant. There were postoperative complications in 5 patients, and 4 patients required re-intervention but no conversion to total laryngectomy., Conclusion: Conservative surgery is an effective surgical-alternative to chemo-radiotherapy in patients with locally advanced laryngeal cancer, providing oncological control, acceptable complications and minimal sequels. Although most patients have aspiration, this does not affect functional status., (Copyright © 2015. Published by Masson Doyma México S.A.)

Introduction: The goal of conservative surgical treatment of laryngeal cancer is to obtain oncological control with preservation of laryngeal function. The concept of laryngeal function preservation should be understood as the preservation of the patient's ability to breathe normally with neither tracheostomy nor aspiration, and maintaining intelligible speech. This can be achieved by a balance between two fundamental aspects, proper patient selection (based on tumour extension and preoperative laryngeal function), and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy is the voice conservative surgical technique that offers the best possibility of control in patients with locally advanced laryngeal cancer. The proper histopathological analysis allows staging and selecting patients for adjuvant therapy, avoiding unnecessary ones as well as designing monitoring and surveillance programs based on risk factors., Objective: To highlight key points in the histopathological evaluation of the surgical specimen of a subtotal laryngectomy., Conclusion: The proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumour leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathological evaluation of the surgical specimen., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

Introduction and Objectives: It is unknown if patients who suffer from laryngeal cancer and undergo total laryngectomy experience as much emotional shock and psychological distress as patients with cancers in other locations do. The aim of the study was to identify the incidence of emotional and psychological disorders in laryngectomized patients and describe their symptomatological nuances., Methods: A descriptive cross-sectional study of emotional and psychopathological response of 100 cancer patients undergoing total laryngectomy was performed. The patients were evaluated immediately after surgery (n=35), when initiating communicative rehabilitation (n=23) and 5 years after diagnosis (n=42), versus a control of 55 healthy subjects. Psychopathological assessment battery for anxiety, depression, intrusion, avoidance, arousal and posttraumatic stress disorder consisted of a specific interview, the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R)., Results: Laryngectomized patients had low incidence of emotional and psychological disorders such as anxiety (6.9%), depression (5.9%) and/or posttraumatic stress disorder (28.4%), but with sufficient intensity to constitute a psychopathological diagnosis. A significant level of distress was found in 57.4% of patients, with clear diffuse traumatic nature in 52.6% of them, which was more prevalent and intense in the rehabilitation group., Conclusions: Symptoms of anxiety, depression and posttraumatic stress disorder during different stages after total laryngectomy are not of sufficient intensity and quality to be diagnosable clinical entities; they can be considered an adaptive disorder. The symptoms are less than those of patients with cancer in other locations and appear mostly in the rehabilitation stage, where preventive performances and psychological support should be focused., (Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.)

Introduction and Objectives: Total laryngectomy (TL) and postoperative radiotherapy (RT), when indicated, have proven to be effective in treating cases of locally advanced laryngeal cancer. The aim of this study was to analyse the oncological outcomes of this procedure in patients with laryngeal cancer classified T3 and T4a., Methods: We studied 80 patients (51 T3 and 29 T4a) with primary squamous cell carcinoma of the larynx who underwent TL between 1998 and 2006. Bilateral neck dissection was performed in 54 patients, unilateral in 11, and central in 4. Twenty patients (25%) received postoperative radiotherapy., Results: Mean age was 64 years with a male predominance (97%). As for habits, 96% were smokers and 89% consumed alcohol. Lymph node metastases occurred in 44% of patients and extracapsular invasion in 37% of them. All cases had tumour-free margins. In all, 25% of patients had loco-regional recurrence and 5% developed distant metastases. The 5-year disease-specific survival was 72% and 5-year overall survival was 55%. Variables associated with decreased disease-specific survival were T4 classification (P=.068), N2-N3 classifications (P=.005), extracapsular invasion (P=.018) and stage iv disease (P=.009). On multivariate analysis, the only variable associated with decreased disease-specific survival was the presence of N2-N3 nodal metastases (P=.008)., Conclusions: TL is an effective treatment for the management of patients with locally advanced laryngeal cancer. Organ preservation protocols should achieve similar oncological results to those obtained with TL., (Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.)