The preepiglottic space revisited: is it significant?

One hundred fifty-four laryngeal specimens were examined by a serial sectioning method to determine the importance of the preepiglottic space (PES) in the spread of cancer. Controversy surrounds the status of the PES in the two major TNM classifications regarding laryngeal anatomy. However, both the UICC (International Union Against Cancer) and the AJCCS (American Joint Commission on Cancer Staging) imply a T3 grading for tumors invading the PES. Several variables relating to laryngeal cancer spread were entered into a computer program designed to calculate statistical relationships. Of all laryngeal cancers, PES invasion usually occurred in association with primary supraglottic tumors. Preepiglottic space invasion was also found in association with more than half of the cases involving base of tongue and strap muscle invasion. It was also noted in more than half of the cases with transglottic cancer spread. Statistically, these relationships were all highly significant. These findings suggest that PES invasion should be considered equivalent to the spread of cancer outside the larynx, and should therefore be assigned a T4 localized even when advanced, casting doubt on supraglottic partial laryngectomy as a curative procedure in all but the earliest supraglottic tumors.