What is the role of primary surgery in the treatment of laryngeal and hypopharyngeal cancer? Hayes Martin Lecture.

The improvement of XRT techniques and imaging reliability, surgical advances (classical partial procedures and radical surgery), and the appearance of active chemotherapeutic regimens have shifted many paradigms. In particular, a tendency to avoid removing the entire larynx led many teams to assess preservation strategies using chemotherapy as first-line therapy to select candidates for either subsequent XRT or subsequent surgery. Encouraging results have been published. This does not, however, signify that the new standard is to initiate the treatment of any larynx or hypopharynx squamous cell carcinoma (SCC) with chemotherapy and/or XRT and to consider surgery only as a salvage treatment in nonresponders to chemotherapy or for persistent or recurrent diseases after XRT. The aim of this review is to clarify, at the turn of the millennium, the current place of primary surgery in larynx and hypopharynx SCC.