Laryngeal Cancer Surgery

Surgery for laryngeal cancer (cancer of the voice box) ranges from a small procedure through the mouth to complete removal of the larynx, according to the size and position of the tumour. The aim is to remove the tumour completely, together with a margin of healthy tissue, while preserving breathing, swallowing and speech at the best possible level. Which method is chosen is determined by the assessments made before surgery and by the decision of the tumour board.

Endoscopic (through the mouth) surgery

In early-stage tumours, the tumour is removed without an incision in the neck, through a tube placed via the mouth, with the help of a microscope and a laser or a robotic system (transoral laser microsurgery). The stay after surgery is short, recovery is quick, and because most of the vocal cords can be preserved the quality of the voice usually remains good. This method is preferred when the tumour can be seen fully with the endoscope and is limited in extent.

Partial laryngeal operations

If the tumour is too large to be removed completely by the endoscopic route, but limited enough not to require removal of the whole larynx, only the diseased part of the larynx is removed through an incision in the neck (partial laryngectomy). There are different types, in which the upper part of the larynx, a single side of it, or part of the vocal cords is removed. Because the remaining tissue is sufficient for breathing and speech, no permanent opening in the neck is needed, but relearning to swallow may take some time.

Complete removal of the larynx (total laryngectomy)

In advanced-stage tumours, or where the disease persists after radiotherapy, the whole larynx is removed. In this operation the windpipe is brought out to the front of the neck, and breathing takes place through this permanent opening, called a “stoma”. Because the connection between the mouth and the gullet is reconstructed, the swallowing passage is preserved. As the vocal cords are removed, the natural voice is lost, but it is possible to speak again with voice rehabilitation methods. This subject is described in detail on a separate page.

Neck dissection

Because laryngeal cancer can spread to the lymph nodes in the neck, in many operations the lymph nodes also need to be removed (neck dissection). Even when no spread is seen, this may be done as a precaution in tumours where the risk is high. The removed lymph nodes are examined by the pathologist, and the results are used in deciding whether additional treatment is needed after surgery.

Preparation before surgery

Before the operation, a general health assessment, blood tests and examinations of the lungs and heart are carried out. Stopping smoking before surgery makes wound healing noticeably easier. The extent of the operation, its possible risks, its effects on voice and swallowing, and the recovery process are discussed with your doctor in detail; meeting the speech therapist before surgery makes the process easier afterwards.

After surgery and possible risks

In the first days there may be swelling and pain in the neck; these are controlled with painkillers. Until swallowing is safe, nutrition is provided through a thin tube passed through the nose. The stay after surgery varies from a few days to a few weeks, depending on the type of operation. As with any operation, bleeding, infection and delayed wound healing may occur; specific to laryngeal surgery, a change in voice quality, coughing while swallowing and a temporary leak of saliva (fistula) may develop. The great majority of these problems are resolved under the follow-up of the treatment team.