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

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.