Treatment of unusual or rare laryngeal nonsquamous primary malignancies: radical (total/extended total laryngectomy) or conservative surgery?

PURPOSE: The most appropriate treatment of laryngeal nonsquamous malignancies is a controversial subject, mainly because of the limited number of cases diagnosed. Surgery, which is an obligatory choice in nearly all cases, is sometimes indiscriminately demolitive despite the relatively low locoregional aggressiveness that characterizes certain histotypes and locations. Even in extremely aggressive tumors, where the prognosis is almost invariably unfavorable because of distant metastasis, the suitability of radical surgery should be carefully assessed, especially considering the patient's remaining life quality. The aim of the present investigation was to evaluate the postsurgical oncological results in a series of consecutive patients with laryngeal nonsquamous primary malignancy. METHODS: We analyzed retrospectively 29 consecutive patients with laryngeal nonsquamous malignancies of whom 10 underwent total laryngectomy and 19 conservative surgery (partial laryngectomies). RESULTS: Of the 29 patients with of laryngeal nonsquamous malignancies, 16 were alive and free from disease after treatment, 5 died of other causes, 1 was lost at follow-up, and 7 died of the disease. Statistical analysis failed in disclosing a significantly different local recurrence rate after conservative surgery vs radical surgery after a mean follow-up period of 5.5 years. CONCLUSIONS: From the preliminary data emerging from the study, it seems that in nonsquamous malignancies of the larynx, the surgical approach should be the most conservative surgery possible, tailored to neoplasm extent and patient conditions. Although cervical lymph node metastases are unusual, long-term follow-up is mandatory considering the relatively high incidence of distant metastases even after years.