• Home
  • Practice Focus
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
    • How I Do It
    • TRIO Best Practices
  • Business of Medicine
    • Health Policy
    • Legal Matters
    • Practice Management
    • Tech Talk
    • AI
  • Literature Reviews
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Career
    • Medical Education
    • Professional Development
    • Resident Focus
  • ENT Perspectives
    • ENT Expressions
    • Everyday Ethics
    • From TRIO
    • The Great Debate
    • Letter From the Editor
    • Rx: Wellness
    • The Voice
    • Viewpoint
  • TRIO Resources
    • Triological Society
    • The Laryngoscope
    • Laryngoscope Investigative Otolaryngology
    • TRIO Combined Sections Meetings
    • COSM
    • Related Otolaryngology Events
  • Search

The Role of Pulmonary Function Testing Prior to Partial Laryngeal Surgery

by Harrison Cash, MD, Tanya K. Meyer, MD, and Zain H. Rizvi, MD • July 18, 2023

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summary below includes the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.

You Might Also Like

  • Should We Routinely Use Pulmonary Function Testing in the Management of Subglottic Stenosis?
  • What Is the Role of Laryngeal Reinnervation Surgery for Adults with Unilateral Vocal Fold Paralysis?
  • What Is the Role of Laryngoscopy in Angioedema Isolated to the Lips, Without Laryngeal Symptoms?
  • Psychophysical Testing of Chemosensory Function During COVID-19 Infection Shows Recovery Trend
Explore This Issue
July 2023

BACKGROUND

Laryngeal conservation surgery includes open and endoscopic approaches that address select malignant laryngeal lesions to achieve local control while preserving function. Partial laryngectomy in select T1–T3 tumors can provide excellent long-term oncologic and functional outcomes while sparing the morbidity of radiation therapy or total laryngectomy yet still allowing these options in the future. While the goal is functional organ preservation, partial laryngeal surgery may impact voicing, swallowing, and airway protection. Patient selection is critical, as chronic aspiration may lead to pulmonary complications in those whose baseline pulmonary function is impacted by smoking, age, and medical comorbidities. Although understanding tumor extent helps determine resectability, patient factors such as general health, preoperative swallowing, wound healing capacity, and pulmonary function aid in determining ability to tolerate postoperative aspiration and overall surgical candidacy.

Increased postoperative pulmonary complications have been noted in patients with a history of cardiac failure, functional limitations, or chronic obstructive pulmonary disease (COPD), and those who are current smokers, American Society of Anesthesiologist (ASA) class ≥2, or age ≥60.1 Preoperative pulmonary function testing (PFT) is the standard of care in cardiothoracic surgery to identify patients who may not tolerate reduction in pulmonary reserve and are at risk for pulmonary complications or death. PFT has been proposed as a preoperative measure of pulmonary function and reserve for patients who may have temporary or permanent aspiration secondary to partial laryngeal surgery. Although laryngeal tumors may represent a fixed extrathoracic lesion, conservation surgery is generally indicated for T1, T2, and select T3 tumors, which may not be large enough to restrict airflow or require preoperative tracheostomy.

BEST PRACTICE

There is a paucity of high-quality evidence guiding the appropriate use of preoperative spirometry in the assessment of perioperative partial laryngectomy pulmonary risk, and there is no literature related to endoscopic approaches. Inherent in previous studies, however, are some minimal physiologic and fitness selection criteria for patients undergoing partial laryngeal surgery. As patients undergoing laryngeal conservation surgery are at risk for pulmonary complications, those with underlying contributory comorbidities should be risk stratified. Exercise testing and/or PFTs should be considered in patients with COPD, age ≥60, ASA class ≥2, functional limitations, or congestive heart failure, as evidence exists that these patients are at increased risk for pulmonary complications and merit increased scrutiny. When performed, FEV/1FVC >50% should be considered as a minimum criterion, with ideal candidates demonstrating pulmonary reserve by exercise testing.

Although there is no evidence that one specific value determines surgical candidacy or precisely predicts postoperative pulmonary compromise, this assessment will inform the perioperative risk factors to aid in a shared treatment decision-making process. Ultimately, multi-institutional prospective studies are needed to better understand the role of preoperative testing in evaluating candidacy and pulmonary-related outcomes in patients undergoing open or endoscopic partial laryngeal surgery.

Filed Under: Laryngology, Laryngology, Practice Focus, TRIO Best Practices Tagged With: laryngeal surgery, pulmonary function testingIssue: July 2023

You Might Also Like:

  • Should We Routinely Use Pulmonary Function Testing in the Management of Subglottic Stenosis?
  • What Is the Role of Laryngeal Reinnervation Surgery for Adults with Unilateral Vocal Fold Paralysis?
  • What Is the Role of Laryngoscopy in Angioedema Isolated to the Lips, Without Laryngeal Symptoms?
  • Psychophysical Testing of Chemosensory Function During COVID-19 Infection Shows Recovery Trend

The Triological SocietyENTtoday is a publication of The Triological Society.

Polls

Have you invented or patented something that betters the field of otolaryngology?

View Results

Loading ... Loading ...
  • Polls Archive

Top Articles for Residents

  • Applications Open for Resident Members of ENTtoday Edit Board
  • How To Provide Helpful Feedback To Residents
  • Call for Resident Bowl Questions
  • New Standardized Otolaryngology Curriculum Launching July 1 Should Be Valuable Resource For Physicians Around The World
  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Physician Handwriting: A Potentially Powerful Healing Tool

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Otolaryngologists as Entrepreneurs: Transforming Patient Care And Practice

    • Keeping Watch for Skin Cancers on the Head and Neck

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Complications for When Physicians Change a Maiden Name

    • Physician Handwriting: A Potentially Powerful Healing Tool
    • Leaky Pipes—Time to Focus on Our Foundations
    • You Are Among Friends: The Value Of Being In A Group
    • How To: Full Endoscopic Procedures of Total Parotidectomy
    • How To: Does Intralesional Steroid Injection Effectively Mitigate Vocal Fold Scarring in a Rabbit Model?

Follow Us

  • Contact Us
  • About Us
  • Advertise
  • The Triological Society
  • The Laryngoscope
  • Laryngoscope Investigative Otolaryngology
  • Privacy Policy
  • Terms of Use
  • Cookies

Wiley

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1559-4939