title: Functional outcomes after supracricoid laryngectomy: what do we not know and what do we need to know?
abstract: Supracricoid laryngectomies (SCLs) are conservative organ-sparing surgical techniques for the treatment of selected T2-T4 laryngeal carcinomas. Although these procedures allow preserving the larynx and its functions, in several countries SCLs are not adopted in oncological protocols. One of the possible reasons to account for this choice is the complexity of post-surgical in-hospital management and the variability in functional results. The aim of this review is to analyse the literature on functional results after SCLs as knowledge on functional results will help in focusing on what is needed in the future to reach more standardized post-surgical procedures and homogeneous outcomes. The analysis of the length of hospital stay, feeding-tube removal time and time to eventual tracheotomy decannulation showed a marked variability across authors and centres. Several factors may come into play, including health-system organizations in different countries. In most studies in-depth description of the criteria applied for discharge, tracheotomy tube removal and commencement of oral feeding were not reported. Moreover, the review on swallowing functional outcomes showed marked variability, as well as a lack of consensus on how to assess swallowing after SCLs. The analysis of voice functional outcomes also revealed a marked variability; surprisingly, the tools applied in the assessments were very often not adequate for substitution voice. Literature review showed that voice- and swallowing-related quality of life are often satisfactory but the variability among centres is still too large. Therefore, there is a need for clearer clinical recommendations on early post-surgical management, tracheal-cannula and feeding-tube removal criteria, voice- and swallowing-assessment protocol, rehabilitation need and timing.
authors.affiliation: Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy. antonio.schindler@unimi.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Schindler
authors.affiliation: Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Pizzorni
authors.affiliation: Department of Biomedical and Clinical Sciences, Phoniatric Unit, L. Sacco Hospital, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mozzanica
authors.affiliation: Department of Otorhinolaryngology, Ospedale San Luigi Gonzaga, University of Turin, 10043, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Fantini
authors.affiliation: Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS "Ca' Granda", Ospedal Maggiore Policlinico, University of Milan, 20122, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ginocchio
authors.affiliation: Department of Otorhinolaryngology, Ospedale Civile of Vittorio Veneto, 32029, Belluno, Italy.
authors.forename: Andy
authors.initials: A
authors.lastname: Bertolin
authors.affiliation: Department of Otorhinolaryngology, Ospedale Martini, 10141, Turin, Italy.
authors.forename: Erika
authors.initials: E
authors.lastname: Crosetti
authors.affiliation: Department of Otorhinolaryngology, Ospedale San Luigi Gonzaga, University of Turin, 10043, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Succo
mesh_terms: D003413:Cricoid Cartilage / Q000601:surgery; D003679:Deglutition / Q000502:physiology; D020878:Device Removal; D004750:Enteral Nutrition / Q000295:instrumentation; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods* / Q000592:standards; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D011184:Postoperative Period; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Dysphagia; Dysphonia; Functional results; Laryngeal cancer; Outcome; Quality of life; Supracricoid laryngectomy