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Four principles of organ-preservation surgery help provide consistent oncologic and functional outcomes: local control; accurate assessment of the 3D extent of tumor; cricoarytenoid unit as the basic functional unit of the larynx; and resection of normal tissue to achieve an expected functional outcome.

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Indirect laryngoscopy and staging operative endoscopy are critical to planning conservation laryngeal surgery. Vocal fold fixation must be distinguished from arytenoid fixation, which implies cricoarytenoid joint invasion and is a contraindication to conservation laryngeal surgery.

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The overall health of the patient must be assessed. Patients must tolerate some degree of aspiration in the postoperative period. Pulmonary function tests are rarely used. Instead, if a patient is active in daily life and can walk up two flights of stairs without being winded, he or she may be a candidate for a conservation laryngeal procedure.

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Open organ-preservation options for glottic carcinomas include vertical partial laryngectomy (VPL) and supracricoid partial laryngectomy with cricohyoido-epiglottopexy (SCPL-CHEP).

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The classic VPL and its extensions all share a common approach, which includes a vertical transaction through the thyroid cartilage and paraglottic space, as well as a “blind” entry into the larynx through a narrow exposure.

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Functional results with VPL are variable depending on the extent of resection and the type of reconstruction, which varies from imbrication laryngoplasty, to strap muscle flap, to epiglottic laryngoplasty.

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Oncologic results for VPL are excellent with T₁ glottic carcinomas, but VPL should be avoided with advanced T₂ lesions and all T₃ and T₄ glottic lesions.

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The main use for SCPL-CHEP has been in selected T₂ and T₃ glottic carcinomas, with local control rates greater than 90%. The SCPL-CHEP does not resect the entire supraglottis, so for transglottic tumors, the supracricoid partial laryngectomy with cricohyoidopexy is preferred.

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Functional results with SCPL-CHEP are predictable due to the identical resection and reconstruction in all cases. Long-term dysphagia is rare.

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Organ-preservation options for supraglottic carcinomas include the supraglottic laryngectomy and the supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP).

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Supraglottic laryngectomy has produced excellent oncologic results for T₁ and T₂ supraglottic carcinomas with local control rates greater than 90%, but outcomes are extremely variable with advanced lesions.

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Voice results for supraglottic laryngectomy are typically excellent, although a certain degree of temporary dysphagia is to be expected, with more severe dysphagia expected with extended procedures.

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SCPL-CHP is indicated for supraglottic carcinomas in which there is glottic level involvement, pre-epiglottic space involvement, decreased vocal fold mobility, or limited thyroid cartilage invasion.

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The oncologic success of the SCPL-CHP is attributed to the en bloc resection of bilateral paraglottic spaces, the preepiglottic space, and the entire thyroid cartilage.

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Contraindications to the SCPL include (1) subglottic extension greater than 10mm anteriorly and 5mm posteriorly; (2) arytenoid fixation; (3) massive preepiglottic space involvement with involvement of the vallecula; (4) extension to the pharyngeal wall, vallecula, base of tongue, postcricoid region, and interarytenoid region; and (5) cricoid cartilage invasion.

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Transoral Robotic Surgery (TORS) is a new technique that offers an alternative to open and transoral laser approaches for the treatment of glottic and supraglottic carcinomas.