Subtotal and total glossectomies with or without total laryngectomy - Does laryngeal preservation impact oncological and functional outcomes?

Objective: Subtotal (SG) and total glossectomies (TG) represent surgical options for advanced oral and oropharyngeal squamous cell carcinomas (SCC). Associated laryngeal preservation maintains phonation but increases the risks of aspiration pneumonia and, potentially, local recurrence in the vallecular/supraglottic area. To mitigate these risks, SG/TG with total laryngectomy (TL) may be performed. This study evaluates functional and oncological outcomes of SG/TG with/without TL, focusing on the clinical impact of laryngeal preservation. Methods: This monocentric retrospective study analysed patients treated by SG/TG with/without TL between January 2013 and July 2024 in a referral, high-volume, academic institution. Oncological outcomes were assessed by overall (OS) and disease-free survival (DFS). Functional outcomes were evaluated in terms of gastrostomy- and tracheotomy-dependency. Results: Among 67 patients analysed, 56 (83.6%) underwent SG/TG without TL and 11 (16.4%) with TL. Gastrostomy-dependency at discharge was 83.6%, with minimal differences between laryngeal preservation (83.9%) and TL (81.8%). Tracheotomy-dependency in case of laryngeal preservation was 16.7% at 12 months. Five-year OS was 23.1%. No significant differences in terms of OS or DFS were observed between SG/TG with or without TL. Conclusions: Laryngeal preservation in SG/TG, when oncologically safe, does not worsen survival outcomes and offers better functional recovery. Gastrostomy dependency remains high across both groups, suggesting that laryngeal sacrifice does not confer significant nutritional advantages. State of the art reconstructive techniques using microvascular flaps facilitate laryngeal preservation without compromising survival.