Laryngeal squamous cell carcinoma: analysis of oncologic and functional outcomes after surgical treatment with transoral laser microsurgery, open partial laryngectomies and total laryngectomy

Background: Treatment of laryngeal squamous cell carcinoma (LSCC) can either surgical or with chemo/radiotherapy. Recent technological advancements have allowed to refine patient selection and significantly increase the number of patients treated with organ-preservation protocols (TLM, OPHLs and C/RT). The oncologic and functional outcomes of surgically treated patients should be thoroughly studied to improve patient selection and define clinically relevant predictive/prognostic factors. Methods: Prospective data collection and retrospective analysis of patients undergoing surgery for LSCC. The analysis consisted of defining the decisional regret and relative impact of psychometric profile in patients undergoing OPHL; defining the prognostic impact of staging discrepancies on the oncologic outcomes of patients undergoing OPHL; defining the impact of Charslon’s comorbidity index (CCI) and Modified Frailty Index (mFI) on the functional results of partial laryngectomies; and to compare different treatment strategies for cT3/pT3 LSCCs. Results: Each of these projects have been described in a specific section of the thesis where a scientific article outline (abstract, introduction, methods, results, discussion, conclusions) has been reported. Conclusions: Surgical treatment of LSCC is effective and safe. Patient selection is crucial and requires thorough clinical and radiological work-up to reduce staging discrepancies and improve patient outcomes of patients treated with OPHLs. Functional outcomes are satisfactory in the vast majority of patients and CCI/mFI may help in quantifying the morbidity load and improve the patient’selection criteria for surgical organ-preserving protocols. Decisional regret after OPHL is low and is influenced by patient’s psychological attitude.