Laryngeal Transplantation in Cancer Patients: Evaluation of Surgical Outcomes and Functional Recovery

Laryngeal transplantation offers a promising avenue for functional restoration following total laryngectomy, yet concerns regarding cancer recurrence and perioperative challenges persist. This pilot study evaluates the preliminary outcomes of a refined surgical technique and postoperative follow-up protocol specifically for cancer patients. Between 2023 and 2024, four patients underwent laryngeal transplantation at West China Hospital, with immunosuppressive therapy, microbial prophylaxis, and postoperative rehabilitation. Over a follow-up period ranging from 10 to 26 months, outcomes were heterogeneous. Two recipients (T4 laryngeal squamous cell carcinoma) achieved excellent functional recovery in swallowing and phonation with sustained rejection-free survival for 20 and 23 months and disease-free survival for 20 and 26 months, respectively, though both remained tracheostoma dependent. One of these survivors is currently undergoing treatment for graft rejection after unilateral cessation of immunosuppressants. The remaining two patients succumbed to severe pneumonia with sepsis and tumor recurrence at 10 and 11 months posttransplant. Functional assessments in surviving cases indicated progressive nerve regeneration, with optimal voice and swallowing outcomes achieved approximately 6-8 months postsurgery. Ultimately, these findings demonstrate the technical feasibility of laryngeal transplantation in a pilot cohort of cancer patients, providing critical data for future protocol refinement.