Surgical options for Supraglottic Cancers

As is apparent from the treatment algorithms, many surgical options can achieve clear margins and preserve laryngeal function

Surgical options include:

• Transoral endoscopic microsurgery (cold steel) or extended Bovie via Lindholm
• Transoral microscopic CO2 laser surgery
• Suprahyoid approach and resection (page 9): May be considered to access and resect T1 tumours of suprahyoid epiglottis or arytenoid or aryepiglottic fold
• Supraglottic laryngectomy (Requires swallowing therapy expertise)
• Supracricoid laryngectomy (Requires swallowing therapy expertise)
• Total laryngectomy
• Partial pharyngectomy (may require flap reconstruction)

Type of surgery depends on

• Tumour factors
  • Site
  • Cartilage invasion
  • Stage
  • Involvement of arytenoid complex

• Prior therapy
  • Radiation
  • Partial laryngectomy

• Patient factors
  • Pulmonary status (tolerate aspiration)
  • Cognitive status (To work with Speech and Language Therapist)

• Institutional support
  • Surgical expertise
  • Availability of CO2 laser / transoral microsurgery
  • Speech and swallowing support
  • Tracheo-oesophageal speaking valves

Index: Clinical Practice Guidelines for Supraglottic Cancer

Resource Appropriate Supraglottic Cancer Guideline Scenarios