Klaske van Sluis

General introduction 7 Figure 1.1: Schematic drawing of a lateral view of the normal anatomy with the larynx in situ. tor’s preferences [8]. Working towards an educated treatment choice is referred to as shared decision making. Three main indications for total laryngectomy are present. Firstly, a total laryngectomy can be a primary treatment for ad- vanced laryngeal and hypo-pharyngeal cancers, the T3 and T4 staged cancers. These cancers can be primary, the first diagnosed cancer, or secondary pri- mary; the latter referring to a new primary cancer in a patient that already had cancer. A total laryngectomy for primary cancer is typically combined with post-laryngectomy (chemo)radiotherapy, whereas patients with secondary primary cancer often have already received (chemo)radiotherapy for their first cancer [4, 9, 10]. Secondly, a total laryngectomy can be a salvage treatment in case of recurrent or residual disease that is not successfully treated with organ- preserving treatment, such as (chemo)radiotherapy [10]. In approximately one fourth of the patients with advanced larynx cancer, this salvage treatment needs to be performed since the (chemo)radiotherapy or minimally invasive proce- dures were not sufficient [11, 12]. Finally, laryngeal functionality can become so impaired due to previous (chemo)radiotherapy that a total laryngectomy is required [13, 14]. In this case the procedure is performed as a result of a dysfunctional larynx. Patients with a dysfunctional larynx often suffer ongoing aspiration and/or obstruction in breathing which makes them dependent on a tracheotomy, e.g. a canulla [13, 14]. The surgical procedure of a total laryngectomy generally involves removal of the larynx, resection of the trachea, removal of the hypopharynx in accordance with the extent of invasion and reconstruction of the neopharynx. In case of