Annals of Surgical Oncology

, Volume 23, Issue 5, pp 1674–1683 | Cite as

Tracheal Autotransplantation for Functional Reconstruction of Extended Hemilaryngectomy Defects: A Single-Center Experience in 30 Patients

  • Elke Loos
  • Jeroen Meulemans
  • Jan Vranckx
  • Vincent Vander Poorten
  • Pierre Delaere
Head and Neck Oncology



Tracheal autotransplantation is a reconstructive technique that allows for organ-sparing treatment of selected patients with advanced cricoid cartilage chondrosarcoma and T2 or T3 laryngeal squamous cell carcinoma (SCC) (unilateral T2 with impaired vocal fold mobility; T3 with subglottic extension and/or arytenoid cartilage fixation). This study evaluated the functional and oncologic outcomes of an optimized autotransplant technique that the authors have been using since 2003.


The study retrospectively reviewed the charts of all patients who underwent tracheal autotransplantation at the authors’ center between 2003 and 2015.


The cohort included 30 patients: 7 with cricoid chondrosarcoma and 23 with laryngeal SCC. The median age of the patients was 60.5 years. The median follow-up period was 78 months. The 3- and 5-year overall survival rates were respectively 92 and 80 %, and the cause-specific survival rates were respectively 100 and 96 %. Only one patient experienced tumor recurrence. The temporary tracheostomy was closed in 22 patients (73 %). The laryngeal preservation rate was 90 %, with 25 patients (83 %) obtaining a functional voice and 25 patients (83 %) resuming normal oral feeding. The univariate analysis showed advanced age (>65 years) as a negative prognostic factor for functional outcome but exhibited no statistical influence of gender, tumor type or stage, or previous radiotherapy. Strikingly, all chondrosarcoma patients experienced optimal functional outcomes.


For this particular group of patients, the authors’ tracheal autotransplantation technique provides excellent functional results for respiration, speech, and swallowing without compromising the oncologic outcome. This is particularly true for patients younger than 65 years and for those with cricoid chondrosarcoma.


Chondrosarcoma Laryngeal Squamous Cell Carcinoma Total Laryngectomy Transoral Laser Microsurgery Larynx Preservation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

There are no conflicts of interest.


  1. 1.
    Lagha A, Chraiet N, Labidi S, Rifi H, Ayadi M, Krimi S, et al. Larynx preservation: what is the best nonsurgical strategy? Crit Rev Oncol Hematol. 2013;88:447–58.CrossRefPubMedGoogle Scholar
  2. 2.
    Ramakrishnan Y, Drinnan M, Kwong FNK, Grant DG, Mehanna H, Jones T, Paleri V. Oncologic outcomes of transoral laser microsurgery for radiorecurrent laryngeal carcinoma: a systematic review and meta-analysis of English-language literature. Head Neck. 2014;36:280–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Delaere PR, Hermans R. Tracheal autotransplantation as a new and reliable technique for the functional treatment of advanced laryngeal cancer. Laryngoscope. 2003;113:1244–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Delaere P, Vander Poorten V, Vranckx J, Hierner R. Laryngeal repair after resection of advanced cancer: an optimal reconstructive protocol. Eur Arch Otorhinolaryngol. 2005;262:910–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Delaere P, Goeleven A, Vander Poorten V, Hermans R, Hierner R, Vranckx J. Organ preservation surgery for advanced unilateral glottic and subglottic cancer. Laryngoscope. 2007;117:1764–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Delaere PR, Vranckx JJ, Dooms C, Meulemans J, Hermans R. Tracheal autotransplantation: guidelines for optimal functional outcome. Laryngoscope. 2011;121:1708–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;31:845–52.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hartl DM. Evidence-based practice: management of glottic cancer. Otolaryngol Clin North Am. 2012;45:1143–61.CrossRefPubMedGoogle Scholar
  10. 10.
    Hartl DM, Brasnu DF, Shah JP, Hinni ML, Takes RP, Olsen KD, et al. Is open surgery for head and neck cancers truly declining? Eur Arch Otorhinolaryngol. 2013;270:2793–802.CrossRefPubMedGoogle Scholar
  11. 11.
    Schultz P. Vocal fold cancer. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:301–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Canis M, Ihler F, Martin A, Wolff H, Matthias C, Steiner W. Results of 226 patients with T3 laryngeal carcinoma after treatment with transoral laser microsurgery. Head Neck. 2014;36:652–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Baatenburg RJ, Jong D, Lent S Van, Hogendoorn PCW. Chondroma and chondrosarcoma of the larynx. Curr Opin Otolaryngol Head Neck Surg. 2004;12:98–105.CrossRefGoogle Scholar
  14. 14.
    Sauter A, Bersch C, Lambert KL, Hörmann K, Naim R. Chondrosarcoma of the larynx and review of the literature. Anticancer Res. 2007;27:2925–30.PubMedGoogle Scholar
  15. 15.
    Rinaldo A, Howard DJ, Ferlito A, et al. Laryngeal chondrosarcoma: a 24-year experience at The Royal National Throat, Nose, and Ear Hospital. Acta Otolaryngol. 2000;120:680–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Maclean J, Cotton S, Perry A. Postlaryngectomy: it’s hard to swallow: an Australian study of prevalence and self-reports of swallowing function after a total laryngectomy. Dysphagia. 2009;24:172–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Sweeny L, Golden JB, White HN, Magnuson JS, Carroll WR, Rosenthal EL. Incidence and outcomes of stricture formation postlaryngectomy. Otolaryngol Head Neck Surg. 2012;146:395–402.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Maclean J, Szczesniak M, Cotton S, Cook I, Perry A. Impact of a laryngectomy and surgical closure technique on swallow biomechanics and dysphagia severity. Otolaryngol Head Neck Surg. 2011;144:21–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Ward EC, Bishop B, Frisby J, Stevens M. Swallowing outcomes following laryngectomy and pharyngolaryngectomy. Arch Otolaryngol Head Neck Surg. 2002;128:181–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Moon S, Raffa F, Ojo R, Landera Ma, Weed DT, Sargi Z, et al. Changing trends of speech outcomes after total laryngectomy in the 21st century: a single-center study. Laryngoscope. 2014;124:2508–12.CrossRefPubMedGoogle Scholar
  21. 21.
    Leong SC, Upile N, Lau A, Lancaster J, Praveen P, Rogers SN, et al. Extended vertical hemilaryngectomy and reconstruction with a neovascularised tracheal autograft for advanced unilateral laryngeal tumours: a learning curve. Eur Arch Otorhinolaryngol. 2014;271:1729–3522.CrossRefPubMedGoogle Scholar
  22. 22.
    Delaere P, Vranckx J, Verleden G, De Leyn P, van Raemdonck D. Tracheal allotransplantation after withdrawal of immunosuppressive therapy. N Engl J Med. 2010;362:138–45.CrossRefPubMedGoogle Scholar
  23. 23.
    Delaere PR, Vranckx JJ, Meulemans J, Vander Poorten V, Segers K, Van Raemdonck D, et al. Learning curve in tracheal allotransplantation. Am J Transplant. 2012;12:2538–45.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Elke Loos
    • 1
  • Jeroen Meulemans
    • 1
  • Jan Vranckx
    • 2
  • Vincent Vander Poorten
    • 1
  • Pierre Delaere
    • 1
  1. 1.Department of Otorhinolaryngology-Head and Neck SurgeryUniversity Hospital LeuvenLeuvenBelgium
  2. 2.Department of Plastic and Reconstructive SurgeryUniversity Hospital LeuvenLeuvenBelgium

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