Open Partial Horizontal Laryngectomy in the Elderly: Oncological and Functional Outcomes.

Objectives: The aim of the present study was to investigate the oncological and functional prognostic implication of perioperative risk factors in the elderly patient who underwent open partial horizontal laryngectomy (OPHL).

Study design: A single institution, retrospective case-cohort study.

Methods: The present study retrospectively reviewed the clinical charts of a cohort of 100 elderly laryngeal squamous cell carcinoma (LSCC) patients who underwent OPHL at our institution. Oncological and functional results were evaluated through univariate analysis.

Results: The overall recurrence rate was 19%. The 2 years overall and disease-specific survivals were 72% and 90%, respectively. No perioperative deaths were reported. A postoperative complication was reported in 20 cases (20%). Fifty-four patients (54%) were decannulated during the hospitalization. A percutaneous endoscopic gastrostomy procedure was performed in 12 patients (12%) due to persistent dysphagia. Twenty-six patients experienced postoperative late sequelae (26%), in terms of postoperative laryngeal obstruction (POLO) in 17 cases. A total of 80 patients (80%) were finally successfully decannulated. A functional total laryngectomy was performed in 6 cases.

Conclusions: The indication to OPHL should be carefully evaluated in the elderly. In appropriately selected patient, OPHL represents a safe and effective therapeutic option. Cervical positive nodes and an incomplete resection of the tumor with positive surgical margins remain in such population the main prognostic factors for the oncological outcome, these factors have a negative impact on the functional outcome too, due to the need for adjuvant treatment. Hence, OPHL should be offered as a single-modality treatment especially in the elderly.

Level of evidence: 4 Laryngoscope, 2025.