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

Summary 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.