ACTA Otorhinolaryngologica Italica

Update on laryngeal cancer

Giuseppe Tortoriello — 2026-05-19

The histopathological spectrum of laryngeal epithelial neoplasia

Elena Bellan — 2026-05-19

The larynx may harbour a wide spectrum of benign, precursor, and malignant lesions. While benign entities predominate, malignant tumours – most commonly keratinising squamous cell carcinoma – pose significant diagnostic and therapeutic challenges due to their histologic and biological heterogeneity. Accurate histopathological evaluation is therefore essential for appropriate classification, prognostication, and optimal clinical management of laryngeal neoplasms. This review outlines the principal pathological features of laryngeal precursor lesions and malignant neoplasms, with emphasis on conventional squamous cell carcinoma and its major variants. Key differential diagnostic considerations and prognostic implications are discussed, along with a brief overview of emerging biomarkers and immunotherapeutic strategies for advanced and recurrent disease.

Videomics and artificial intelligence in endoscopic diagnosis of laryngeal lesions: mapping current evidence through a scoping review

Alessandro Ioppi — 2026-05-19

Laryngeal lesions are common and despite advances like high-definition videolaryngoscopy and enhanced imaging modalities such as narrow-band imaging, laryngoscopy remains operator-dependent. In this setting, artificial intelligence (AI) represents a promising tool to support clinical evaluation. This scoping review evaluated the current applications of AI in the endoscopic diagnosis of laryngeal lesions. A comprehensive search of MEDLINE and Scopus databases included 35 studies addressing AI-based detection, classification, or segmentation of laryngeal pathologies. Detection models frequently achieved real-time inference speeds and strong performance metrics although external validation was limited. Classification studies showed particularly robust results for binary tasks distinguishing high-risk from low-risk lesions, with some models achieving sensitivity and accuracy exceeding 90%. Segmentation models demonstrated the potential for precise delineation of cancer margins, a capability of notable relevance for surgical planning and intraoperative decision-making. Despite promising advances, heterogeneity in study design, limited external validation, and reliance on single-centre datasets currently restrict broad clinical implementation. Nonetheless, the emerging integration of AI into laryngeal endoscopy represents a significant step toward reproducible and accessible diagnostic assessment.

Radiomics in laryngeal squamous cell carcinoma: state of the art

Sonia Lucchese — 2026-05-19

Laryngeal squamous cell carcinoma (LSCC) is one of the most common malignancies of the head and neck, and accurate staging is essential for optimal therapeutic decision-making. However, discrepancies between clinical-radiological staging and pathological findings, particularly in the assessment of thyroid cartilage invasion and lymph node involvement, may result in inappropriate treatment decisions. Radiomics has recently emerged as a quantitative imaging approach capable of extracting high-dimensional features from medical images, providing objective biomarkers that reflect tumour heterogeneity beyond visual assessment. This narrative review summarises current evidence on radiomics applications in LSCC, including staging, cartilage invasion assessment, nodal evaluation, and prognostic stratification, and outlines the main steps of the radiomic workflow together with current methodological challenges. Recent studies indicate that radiomics, particularly when integrated with deep learning and clinical data, improves diagnostic and prognostic performance compared with conventional imaging alone. However, methodological heterogeneity and limited external validation still restrict routine clinical implementation, and further standardisation and prospective multicentre validation are required before widespread clinical adoption.

Margin burden and postoperative management after transoral laser microsurgery for laryngeal glottic squamous cell carcinoma: a multicentre retrospective study on 1216 patients

Francesco Chu — 2026-05-19

Objective. To evaluate the prognostic impact of surgical margin burden and postoperative management after transoral laser microsurgery (TOLMS) for glottic laryngeal squamous cell carcinoma (LSCC) in a large multicentre cohort.
Methods. A retrospective multicentre study included 1216 patients with pT1-pT3 LSCC treated with TOLMS. Surgical margins were classified as free, single superficial positive, multiple superficial positive, or deep positive. Disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) were analysed using Kaplan-Meier estimates and multivariable Cox models, accounting for pathological stage and postoperative management.
Results. Pathological T category was independently associated with DFS and DSS. A single superficial positive margin showed DFS comparable to free margins. Multiple superficial positive margins were associated with increased recurrence risk, while deep margin involvement was strongly associated with both recurrence (hazard ratio [HR] 3.96) and disease-specific mortality (HR 6.82). Among patients with positive margins, second-look surgery achieved better DFS than postoperative radiotherapy or surveillance. Residual carcinoma at revision surgery was a major predictor of poor DFS and DSS.
Conclusions. After TOLMS, oncologic risk is driven by margin type and burden rather than margin positivity alone. Deep margin involvement and residual disease identify patients requiring intensified management, supporting a risk-adapted postoperative strategy.

Salvage open partial horizontal laryngectomy: a comprehensive systematic review of oncological and functional outcomes

Andy Bertolin — 2026-05-19

Objective. To evaluate the oncological and functional outcomes of salvage open partial horizontal laryngectomy (OPHL) following failure of transoral laser microsurgery (TOLMS) (chemo)radiotherapy [(C)RT].
Methods. A comprehensive systematic review was conducted, analysing survival rates (overall survival [OS], disease-specific survival [DSS], and local control [LC]), laryngeal preservation, and functional recovery (decannulation and swallowing) in the salvage setting.
Results. Salvage OPHL offers oncological outcomes comparable to total laryngectomy (TL) in strictly selected patients. Meta-analyses report 5-year OS rates of 71-83% and LC around 87%. Outcomes are significantly superior for post-TOLMS recurrences compared to post-(C)RT failures. In the post-TOLMS setting, organ preservation reaches 95.3%. Conversely, irradiated tissues are prone to higher morbidity, including chronic oedema, chondronecrosis, and pexy rupture. While functional recovery is substantially longer after RT – with decannulation and nasogastric feeding tube removal times often doubling – the final success rate remains high, with over 90% of patients regaining oral feeding and airway patency within one year.
Conclusions. Salvage OPHL is a powerful organ-preservation tool. Success depends on rigorous patient selection, accurate restaging (addressing frequent clinical understaging), and the preservation of at least one functional cricoarytenoid unit. While functionally demanding, it provides a superior quality of life compared to TL by avoiding a permanent tracheostoma and maintaining laryngeal voice.

A systematic review of surgical outcomes and postoperative complications based on free flap selection for reconstructing primary or recurrent locally advanced laryngeal-hypopharyngeal tumours

Pietro De Luca — 2026-05-19

Objective. To evaluate surgical outcomes and postoperative complications according to free flap selection in patients undergoing reconstruction after total or extended pharyngolaryngectomy for locally advanced (cT3-T4a) laryngeal-hypopharyngeal squamous cell carcinoma (SCC).
Methods. A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, EMBASE, Cochrane and OVID databases were searched for studies published between 2000 and 2025. Adult patients undergoing partial or circumferential pharyngeal reconstruction with free flap reconstruction were included. Outcomes of interest were flap failure, pharyngocutaneous fistula (PCF), stricture and functional results. Odds ratios (OR) were calculated when feasible.
Results. Twenty-three retrospective studies including 1,849 patients were analysed. The jejunal free flap (JFF) was the most commonly used reconstruction (78%), followed by the anterolateral thigh (ALT) flap (5%). Overall flap survival was high, with total flap necrosis occurring in 2.7% of cases. JFF reconstruction was associated with lower rates of stricture (3.8%) and PCF (3.3%) compared with ALT (9.2% and 5.5%, respectively). ALT reconstruction showed a significantly increased risk of stricture compared to JFF (OR 2.51, p = 0.0002).
Conclusions. Free flap reconstruction after pharyngolaryngectomy is reliable, with high flap survival rates. The JFF remains associated with lower rates of luminal complications, particularly in circumferential defects, while the ALT flap represents a valid alternative. Flap selection should be individualised, and further prospective studies with standardised outcomes are warranted.

Crico-tracheal resection and anastomosis for primary and secondary tumours of the laryngo-tracheal junction: a single centre series of 78 patients

Davide Lancini — 2026-05-19

Objective. The aim of this study is to analyse data related to (crico-)tracheal resection and anastomosis [(C)TRA] for primary or secondary tumours involving the laryngo-tracheal junction, focusing on clinical indications, oncological, and functional outcomes.
Methods. A retrospective analysis was conducted on patients treated by (C)TRA from September 1996 to October 2025 in a single academic tertiary referral centre. Patients were distinguished into 5 subgroups based on tumour histology as: 1) advanced thyroid carcinomas involving the airway, 2) cricoid and tracheal chondrosarcomas, 3) minor salivary gland tumours, 4) squamous cell carcinomas, and 5) other rarer histotypes. Primary endpoints included overall (OS), disease-specific (DSS), and laryngectomy-free survivals (LFS).
Results. The cohort consists of 78 patients submitted to 80 (C)TRA distributed among Types A, B, C, and E. The most frequent histotypes were advanced thyroid carcinomas and chondrosarcomas. The final decannulation rate was 97.4% with an overall complication rate of 27.5%. Five-year OS, DSS, and LFS were 65.4, 76.7, and 95%, respectively.
Conclusions. (C)TRA represents an effective surgical strategy for tumours involving the laryngo-tracheal junction, preserving laryngeal functions without compromising oncologic prognosis. Outcomes are excellent for well-differentiated thyroid or cartilaginous tumours, while caution is warranted in highgrade histologies, extrinsic infiltration from metastatic lymph nodes, or previously irradiated patients.

Five-year outcomes of transoral robotic surgery with or without neoadjuvant chemotherapy in laryngeal squamous cell carcinoma: a preliminary experience

Armando De Virgilio — 2026-05-19

Objective. Organ preservation is a key goal in management of laryngeal cancer. The combination of neadjuvant chemotherapy (NACT) and transoral robotic surgery (TORS) may extend minimally invasive surgery indications, but long-term data remain limited. This study evaluated 5-year oncologic outcomes of TORS with or without NACT in laryngeal squamous cell carcinoma (LSCC).
Methods. We retrospectively analysed 37 LSCC patients treated between 2012 and 2017 with TORS, with NACT administered in advanced-stage disease. Kaplan-Meier analysis was used to estimate overall (OS), disease-specific (DSS), and disease-free survival (DFS). Survival differences were assessed using the log-rank test.
Results. Mean follow-up was 73 months. In patients treated by TORS alone, we observed one-, 3-, and 5-year OS and DSS of 100%, with one-year DFS of 88.9% decreasing to 77.8% at 3- and 5-year, and 100% of laryngeal preservation rate. In patients with locally advanced cT3-4N+ cancer who underwent NACT followed by TORS, 5-year OS, DSS, and DFS were 82.4%, 93.3%, and 61.1%, respectively, with a 84.4% 5-year laryngeal preservation rate.
Conclusions. TORS provides excellent long-term oncologic control in early LSCC. The addition of NACT allows extension to advanced disease while maintaining high laryngeal preservation rates, supporting a multimodal organ-preserving strategy.

The neck matters: optimising lymph node management in laryngeal cancer

Pierre Guarino — 2026-05-19

Objective. Laryngeal squamous cell carcinoma (LSCC) accounts for nearly one quarter of head and neck malignancies, with cervical nodal status representing the strongest prognostic factor. This review aims to summarise evidence on neck management across different clinical scenarios.
Methods. A narrative review of PubMed, Scopus, and Web of Science was conducted up to July 2025. Original studies, systematic reviews, meta-analyses, and clinical guidelines were included. Data were analysed according to clinical setting: cN0, cN+, rcN+, and rcN0.
Results. In primary cN0 LSCC, the risk of occult nodal disease is site-dependent. Supraglottic tumours show the highest incidence (20-50%, > 50% in T3-T4), supporting elective bilateral selective neck dissection (SND) of levels II-IV, with level VI in selected cases. Early glottic tumours rarely metastasise (< 10%) and may be observed, while advanced glottic and subglottic tumours show higher risk (15-30%), justifying elective treatment. In cN+ disease, SND is indicated for N1-N2 and modified radical neck dissection for N3. Regional recurrence occurs in 15-25% of cases. In rcN+ disease, salvage SND provides regional control comparable to comprehensive dissection with lower morbidity. The role of elective dissection in rcN0 remains controversial despite occult metastasis rates > 20% in high-risk tumours.
Conclusions. Neck management in LSCC should be adapted to risk: elective treatment is essential in high-risk cN0 disease, therapeutic dissection remains standard in cN+, and salvage SND is effective in rcN+, while elective treatment in rcN0 should be reserved for selected cases.

Is there a role for adjuvant radiotherapy after partial laryngectomy? A propensity score matched analysis

Liliana Belgioia — 2026-05-19

Objective. To evaluate the impact of postoperative radiotherapy (PORT) on survival outcomes in patients with laryngeal cancer treated with partial laryngectomy.
Methods. In this retrospective multicentre study, 312 patients with supraglottic or glottic squamous cell carcinoma treated with transoral laser microsurgery (TLM) or open partial horizontal laryngectomy (OPHL), with or without PORT between 2005 and 2022 were analysed. Propensity score modelling and inverse probability weighting were applied to balance baseline characteristics. Endpoints included disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS), and locoregional control (LRC).
Results. Of 312 patients, 175 underwent surgery alone and 137 received PORT. Treated patients had more adverse features. PORT significantly improved DFS (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.25-0.77) and LRC (HR 0.06, 95% CI 0.01-0.25). A significant benefit was also observed for DSS (HR 0.40, 95% CI 0.18-0.92). No statistically significant difference in OS emerged (HR 0.75, 95% CI 0.40-1.37).
Conclusions. PORT significantly improves DFS and LRC after partial laryngectomy in high-risk patients, supporting its role in carefully selected cases.

Systemic therapy in the curative treatment of laryngeal cancer

Cristiana Bergamini — 2026-05-19

The aim of this narrative review is to provide a comprehensive overview of systemic approaches in the context of curative treatments for laryngeal squamous cell carcinoma, evaluating oncologic outcomes, survival, and the preservation of voice and swallowing functions. It summarises current evidence from landmark clinical trials, international guidelines, and recent developments in multidisciplinary management, including systemic therapies and advanced radiation techniques. Early-stage laryngeal SCC shows high rates of cure with either surgery or radiotherapy. For locally advanced disease, concurrent chemoradiation remains the nonsurgical standard for organ preservation, though it offers no significant survival advantage over primary surgery. Patient selection is critical; individuals with T4 disease or severe baseline dysfunction often achieve better outcomes with total laryngectomy. While induction chemotherapy and immunotherapy have shown mixed results in definitive settings, neoadjuvant immunotherapy is emerging as a promising approach. Additionally, proton therapy offers potential for reducing late toxicities, such as dysphagia, by better sparing surrounding organs. In conclusion, optimal management of laryngeal cancer requires meticulous multidisciplinary evaluation and personalised treatment. Balancing oncologic control with functional preservation remains the primary challenge, necessitating a shift toward integrated, patient-centred care.

Post-laryngectomy videofluoroscopic assessment in relation to olfactory rehabilitation through the physiological olfactory recovery technique

Giuseppina Mirra — 2026-05-19

Objective. To correlate the anatomo-physiological characteristics of post-laryngectomy changes, assessed by videofluoroscopy, with the outcome and modalities of olfactory rehabilitation using the physiological olfactory recovery technique (PORT).
Materials and methods. From 2019 to 2021, a prospective observational study was conducted at the Department of Otolaryngology-Head and Neck Surgery of Ospedale del Mare, Naples, Italy, on 31 patients who had undergone total laryngectomy with primary placement of a tracheo-oesophageal voice prosthesis. All patients completed a proprioceptive training programme with a speech-language pathologist and learned the PORT method. At the end of the 10-session rehabilitation protocol, all participants demonstrated significant improvement in olfactory perception, which was maintained at long-term follow-up. During subsequent application of PORT in selected patients, notable inter-patient differences emerged in both the modality and timing of response to rehabilitation. This prompted an anatomo-physiological investigation of the post-laryngectomy changes to objectify these variable outcomes. As part of an ongoing collaborative project between the Otolaryngology and Radiology Units aimed at monitoring swallowing and phonatory function in laryngectomized patients, videofluoroscopic examinations were analysed. A total of 31 videofluoroscopic studies performed between February and October 2022 were reviewed.
Results. Differences in patient responses to PORT correlated with individual anatomo-physiological variations in the amount and distribution of air reaching the proximal oesophagus during phonation − defined as the phonatory air bubble (PAB) − as well as with differences in the elasticity of the anatomical district examined. Five distinct types of proximal oesophageal PABs were identified, classified according to post-surgical anatomical characteristics and functional alterations related to adjuvant therapy, particularly radiation-induced fibrosis.
Conclusions. PORT is an effective olfactory rehabilitation technique for laryngectomised patients with a trachea-oesophageal voice prosthesis, including those with complex anatomo-physiological conditions. Accurate interpretation of post-laryngectomy changes is essential for evaluating treatment efficacy: 28 of the 31 patients evaluated physiologically recovered the daily olfactory sniffing manoeuvre, although with variable modalities and timing. Overall, PORT represents a widely applicable and effective method for olfactory rehabilitation in the vast majority of patients with a tracheo-oesophageal voice prosthesis after total laryngectomy.