Total Laryngectomy—Still Cutting-Edge?

SIMPLE SUMMARY: Complete removal of the larynx (total laryngectomy) offers a curative approach for advanced laryngeal and pharyngeal cancer. If the operation is performed after radiotherapy wound healing problems have to be taken into account which can be managed by adapted reconstructive techniques. Laryngectomy results in the loss of voice which can be managed e.g., by using a voice prosthesis with a significant increase in quality of life. Total laryngectomy still represents a relevant surgical procedure in modern head and neck oncology. ABSTRACT: Surgical removal of the larynx (total laryngectomy) offers a curative approach to patients with advanced laryngeal and hypopharyngeal (squamous cell) cancer without distant metastases. Particularly in T4a carcinoma, laryngectomy seems prognostically superior to primary radio(chemo)therapy. Further relevant indications for laryngectomy include massive laryngeal dysfunction associated with aspiration and recurrence after radio(chemo)therapy, resulting in salvage surgery. The surgical procedure including neck dissection is highly standardised and safe. The resulting aphonia can be compensated by functional rehabilitation (e.g., voice prosthesis) associated with a significant quality of life improvement. This article presents an overview of indications, preoperative diagnostics, surgical procedures, including new developments (robotics), possible complications, the choice of adjuvant treatment, alternative therapeutic approaches, rehabilitation and prognosis. In summary, total laryngectomy still represents a relevant surgical procedure in modern head and neck oncology.