Risk of Long-Term Airway Sequelae and Mortality in Laryngeal Chondrosarcoma.

OBJECTIVE: In low- and intermediate-grade laryngeal chondrosarcomas, nonradical surgery or even debulking is considered justifiable to preserve laryngeal function. However, tumor- and treatment-related factors affecting the need for reoperation and long-term risk for tracheostomy remain unclear. METHODS: We retrospectively analyzed 20 patients with laryngeal chondrosarcoma, treated at the Helsinki University Hospital (Helsinki, Finland) between 2000 and 2023. RESULTS: In total, four of 20 (20%) patients primarily underwent total laryngectomy. Sixteen of 20 (80%) patients primarily underwent either open partial laryngectomy or endoscopic debulking. In patients with cricoid cartilage tumors primarily treated with larynx-preserving surgery, reoperation due to tumor recurrence or growth (p = 0.003) and transformation from well or moderately differentiated to poorly differentiated or dedifferentiated histology (p = 0.027) were significantly associated with permanent tracheostomy. Two patients presented with distant metastases and two died of laryngeal chondrosarcoma. CONCLUSION: Patients primarily presenting with low- or intermediate-grade chondrosarcomas may develop higher-grade local recurrence and distant metastases. Due to paradigm shift from radical to function-preserving surgery in laryngeal chondrosarcoma, guidelines are needed for both primary tumor assessment and postoperative surveillance. To minimize the risk of long-term dysfunction and mortality, early detection of unfavorable tumor histology or rapid growth requiring more aggressive treatment is mandatory.