Total laryngectomy for laryngeal cancer 150 years after its first description: A boon more than a calamity: A STROBE analysis

Objective: To illustrate the boon rather than a calamity that total laryngectomy can be for a patient with laryngeal cancer in the 21st century.Material and method: An observational retrospective analysis using the STROBE guideline compared two cohorts of patients with previously untreated cancer, managed by total laryngectomy: the first consist-ing of 123 patients collected by Morell Mackenzie during the fifteen years (1873-1887) following the initial description, and the second consisting of 53 patients consecutively treated in a French university otorhinolaryngology department during the fifteen years (2006-2020) preceding the 150th anniversary of the first performance. The main endpoint was the comparison of survival and locoregional control estimates (Kaplan-Meier life table method). Secondary endpoints comprised mortality estimates and causes, adjuvant treatments, and phonation modalities.Results: The 26.2%, 13.1%, and 13.1% 1-, 3-, and 5-year actuarial survival estimates in the Makenzie cohort increased to 88.6%, 68.4%, and 60.9% in the recent French cohort (P < 0.0001). The 50.1%, 40.4%, and 34.7% 1-, 3-, and 5-year actuarial locoregional control estimates in the Mackenzie cohort increased to 83.7% (P < 0.0001). The 77.7% overall mortality in the Mackenzie cohort decreased to 37.7% (P < .0001). In the Mackenzie cohort, 97.8% of deaths were related to postoperative complications and locoregional recur-rence, compared to 50% in the recent French cohort. Distant metastasis, metachronous second primary tumor and intercurrent diseases, not mentioned in the Mackenzie cohort, generated 45% of deaths in the French cohort. Adjunctive treatment was not used in the Mackenzie cohort, whereas neck dissection and postoperative radiation therapy were associated in respectively 98.1% and 69.8% of cases in the French cohort. Phonation was not documented in the Mackenzie cohort; 50% of survivors in the French cohort used a phonatory implant.Conclusions: The 20th century witnessed an incredible turn-around. Total laryngectomy, with limited indications, has transformed the etiology of deaths and no longer leaves patients in a state of abject misery as Morell Mackenzie put it in 1888. (c) 2022 Elsevier Masson SAS. All rights reserved.

Automated summary

This study compared the survival and treatment outcomes of laryngeal cancer patients in the 19th and 21st centuries through retrospective analysis. The results showed that total laryngectomy has improved survival and locoregional control rates in 21st-century patients, with advancements in adjuvant treatments and phonation modalities.