Early Laryngeal Cancer Timeline: Open Partial Laryngectomy

Open partial laryngectomy removes the part of the larynx that holds the cancer through a cut in the neck and keeps the rest, so speaking and swallowing through the mouth return. It is used less often today and means a longer recovery than the other tracks.

This page is one of three treatment-track timelines for early laryngeal cancer. The steps before treatment, how a track is chosen and the follow-up schedule are covered on the early laryngeal cancer treatment timelines page.

Who follows this track

Most early laryngeal cancers are treated with transoral laser surgery or radiation. Open partial laryngectomy is mainly used when a tumor cannot be removed through the mouth with clear margins but the voice box can still be saved: for example, a less favorable T2 vocal cord cancer that grows deeply or makes a vocal cord move less, especially at the front junction of the vocal cords. For these tumors, the operation controls the cancer in the larynx in about 94 to 100 percent of cases and keeps the voice box in more than 95 percent. It needs an experienced surgical team and good lung function, because some food or liquid may slip toward the airway while swallowing is relearned. It is also used for some small cancers that come back after radiation.

Several types exist: a vertical partial laryngectomy removes one side of the larynx, a supraglottic laryngectomy removes the part above the vocal cords (with a neck dissection), and a supracricoid partial laryngectomy removes more of the larynx while keeping at least one of the small cartilages that move the vocal cords.

Before surgery (weeks 0 to 4)

The scope exam, biopsy, scans, meetings with the care team, voice and swallowing baseline and the tumor board's recommendation are the same on every track and are described on the overview page. Breathing tests (pulmonary function tests) and a swallowing baseline with a speech-language pathologist are added before this operation (see swallow evaluations).

Surgery and hospital stay (about weeks 4 to 6)

• Under general anesthesia, part of the larynx is removed through a cut on the front of the neck (see throat tumor treatments). For supraglottic cancers, a neck dissection is done at the same operation.

• The hospital stay is usually about 1 to 2 weeks, sometimes longer.

• A temporary tracheostomy, a breathing tube in the neck, protects the airway while swelling settles. It is often removed within about 1 to 3 weeks, though it can take longer (about 5 weeks on average after the supracricoid operation), and 85 to 100 percent of people eventually have it removed (see tracheostomy recovery).

• A temporary feeding tube through the nose provides nutrition while the area heals. Swallowing practice with a speech-language pathologist often starts about 1 week after surgery, and the tube is often removed within about 2 to 6 weeks.

On this track, surgery is the end of treatment, so the follow-up clock starts on the day of surgery.

Pathology results (about week 5)

About a week after surgery, the pathologist's report describes the tumor, the margins and any lymph nodes removed (see understanding pathology results). In this timeline the margins are clear and no further treatment is given. If the report shows cancer in the lymph nodes or other worrisome features, radiation, sometimes with chemotherapy, may follow, ideally within about 6 weeks of surgery.

Healing (weeks 4 to 34)

• Aspiration, food or liquid slipping into the airway, is the main early risk. Swallowing therapy teaches techniques that protect the airway, and most people move from liquids to soft foods and then a regular diet (see swallowing problem treatments).

• Swallowing improves over about 6 months, and most people return to a full diet; only about 2 to 5 percent need a long-term feeding tube.

• The voice changes. It takes about 3 to 8 months to settle and is usually rougher than after laser surgery; voice therapy helps.

• Neck healing after a neck dissection is described on the neck dissection recovery page.

• Return to work is often within 1 to 3 months.

Quality of life on this track

Few studies have followed people over time after open partial laryngectomy for early laryngeal cancer, and the ones found describe a dip in the first month and then recovery without publishing the numbers.

• Swallowing: one study of people about 2 years after a supracricoid partial laryngectomy found an average swallowing score of 93 on a 20 to 100 scale, close to normal.

• Voice: results vary widely with the type of operation, and the voice is usually rougher than before.

• Overall and mood: no published averages for early-stage disease were found.

The questionnaires are described on the quality-of-life questionnaires page.

Survival on this track

Survival depends mostly on the stage of the cancer rather than the operation. For T2 vocal cord cancer, about 90 to 94 percent of people do not die of laryngeal cancer within 5 years (disease-specific survival), and overall survival, from any cause, is about 75 to 80 percent. After supracricoid partial laryngectomy for T2 cancer, the cancer is controlled in the larynx in about 94 to 100 percent.

Check-ups and long-term care

• Check-ups follow the usual schedule counted from the end of treatment: every 1 to 3 months in the first year, every 2 to 6 months in the second, every 4 to 8 months in years 3 to 5, then yearly.

• Each visit includes a scope exam of the larynx in the office (see fiberoptic laryngoscopy). Scans are used when symptoms or the exam call for them.

• Swallowing is checked over time. Some people breathe in small amounts of food or liquid without coughing ("silent aspiration"), so coughing or choking while eating, pneumonia or weight loss leads to a repeat swallow study.

• Lymphedema, swelling under the chin or in the neck, can follow a neck dissection and responds best to therapy started early.

• Without radiation, the thyroid, carotid artery and dental effects of radiation do not apply, and radiation remains available if it is ever needed. Regular dental care continues as usual.

• Staying tobacco-free lowers the chance of a new cancer in the lungs, mouth, throat or esophagus.