Name of the Procedure:

Laryngectomy; total, with radical neck dissection
Common name(s): Total Laryngectomy with Neck Dissection, Radical Neck Dissection

Summary

A total laryngectomy with radical neck dissection is a surgical procedure that involves the removal of the entire larynx (voice box) and surrounding lymph nodes in the neck. This operation is often necessary for treating specific advanced cancers within the larynx and nearby regions.

Purpose

• Medical Condition: Advanced laryngeal cancer or other malignancies involving the larynx and surrounding tissues.
• Goals/Outcomes: To remove cancerous tissues, prevent the spread of cancer, and improve survival rates. This procedure may also help alleviate symptoms such as difficulty breathing or swallowing.

Indications

• Persistent or recurrent laryngeal cancer.
• Large tumors in the larynx that do not respond to other treatments.
• Evidence of cancer spread to the neck lymph nodes.
• Severe damage to the larynx due to trauma, infection, or other serious conditions.

Preparation

• Pre-procedure Instructions: Patients may need to fast for several hours before surgery. Some medications may need to be stopped or adjusted.
• Diagnostic Tests: Imaging tests (CT scan, MRI, PET scan), biopsy of the larynx, and blood tests may be required to assess the extent of cancer and overall health.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made in the neck to access the larynx and surrounding structures.
3. Laryngectomy: The entire larynx is carefully removed.
4. Neck Dissection: Radical neck dissection involves removing lymph nodes and possibly other tissues in the neck where cancer may have spread.
5. Tracheostomy: Creation of a permanent opening in the trachea (windpipe) to enable breathing.
6. Closure: The surgical area is closed with sutures, and drainage tubes may be placed to remove excess fluids.

Duration

The procedure typically takes between 5 to 10 hours, depending on the complexity and extent of the cancer.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Surgeons: Typically, an otolaryngologist (ENT specialist) and a head and neck surgeon lead the procedure.
• Nurses: Assist with surgery preparation and patient care.
• Anesthesiologists: Manage anesthesia and monitor vital signs.
• Surgical Technicians: Provide support during the operation.

Risks and Complications

• Common: Bleeding, infection, difficulty swallowing, and changes in voice (loss of natural voice).
• Rare: Damage to nearby nerves or structures, complications from anesthesia, and difficulty breathing.

Benefits

• Removal of cancerous tissues leading to improved survival rates.
• Potential relief from symptoms like obstructed breathing or swallowing difficulties.
• Prevention of cancer spread to other areas.

Recovery

• Post-procedure Care: Patients may stay in the hospital for 1 to 2 weeks. Pain management, wound care, and feeding tubes might be necessary.
• Recovery Time: Full recovery can take several weeks to months. Patients may need speech therapy and rehabilitation.
• Follow-up: Regular follow-up appointments for monitoring healing and detecting any recurrence of cancer.

Alternatives

• Radiation Therapy: Non-surgical option that uses high-energy rays to kill cancer cells.
• Chemotherapy: Use of drugs to kill cancer cells or shrink tumors.
• Partial Laryngectomy: Removing only part of the larynx, preserving some vocal function.
• Pros and Cons:
  • Radiation and chemotherapy might be less invasive but may not be as effective for advanced-stage cancers.
  • Partial laryngectomy preserves more function but may not be suitable for large or aggressive tumors.

Patient Experience

• During Procedure: Patients will be under general anesthesia and will not feel any pain or be aware during the surgery.
• After Procedure: Expect to feel sore and experience some discomfort in the neck area. Pain will be managed with medications. A tracheostomy tube will be present to aid in breathing.
• Long-term: Adaptation to life without a natural voice and potential use of alternative communication methods (e.g., electronic devices).

The road to recovery involves ongoing support from healthcare providers, speech therapists, and support groups to adjust to lifestyle changes and enhance quality of life.