The vertical midline incision is a safe and effective technique for primary total laryngectomy procedures

A total laryngectomy is used to resect laryngeal or hypopharyngeal cancer. Limited research exists on how incision location influences clinical outcomes. This study compares outcomes between 2 incision types; vertical midline (VMI) and apron-type incisions and determines whether this approach should be considered more frequently for primary total laryngectomy procedures. A retrospective analysis was undertaken at 2 tertiary specialist centres. The effect of skin incision technique on postoperative outcomes was analysed using regression modelling. Of the 79 patients included, 54 underwent an apron incision and 25 underwent a VMI. VMIs were significantly associated with reduced risk of lymphoedema (P = 0.011) and pharyngocutaneous fistula (PCF) (P = 0.031). Regression analysis demonstrated incision technique did not influence recurrence (HR2.28; 95% CI 0.61-8.53; P = 0.219) or survival (HR1.41; 95% CI 0.55-3.65; P = 0.477). However, apron incisions increased the odds of minor (OR9.59; 95% CI 1.34-68.82; P = 0.025) and major (OR3.59; 95% CI 1.71-78.21; P = 0.045) complications. VMI is a safe and effective approach for performing laryngectomies and does not have inferior outcomes with regard to complications, recurrence rate or survival. Additional morbidity from the routine use of flap reconstruction in salvage surgery can be avoided. A vertical approach should be considered for laryngectomy resections even in the presence of encapsulated lateral nodal disease.