"Almost Forty!": Four Decades of Open Partial Horizontal Laryngectomy-The Evolving Experience of the Italian School of Enrico de Campora.

Abstract

The objective of this study is to provide a retrospective review of the 40-year experience of three oncology referral centers in the field of reconstructive laryngeal surgery. A multi-institutional retrospective analysis included adult patients who underwent reconstructive laryngeal surgery for cT2-T4a laryngeal cancer (LC) between 1 June 1987 and 1 July 2019. Patients were stratified according to the European Laryngological Society classification for open partial horizontal laryngectomy (OPHL). The final study group included 805 patients (668 men and 137 women). 561 tumors were glottic, while 244 showed supraglottic origin; 644 were considered anterior and 161 posterior. Arytenoid motility was normal in 712 patients, while the motility of the vocal folds appeared to be impaired in 501 patients. All patients underwent OPHL, of which 20 patients underwent OPHL I, 636 patients underwent OPHL II, and 149 patients underwent type III OPHL. 257 patients underwent adjuvant RT based on multiple risk factors/pathological findings. The 5-year overall survival rate was 89.7% (95% CI 87.2-94). The 5-year disease-free survival rate was 78.4% (95% CI 76.8-84.9), and the 5-year disease-specific survival was 64.3% (95% CI 62.2-69.6). Complications were observed in 7.5% of patients, while long-term sequelae were observed in 21% of patients. The findings of this work reveal four decades of surgical evolution in the school of Enrico de Campora. Despite the retrospective analysis and the extremely long follow-up, our analysis shows how OPHLs play a crucial role in LC (even cT4a), with excellent results in terms of functional outcome and organ preservation.