The Role of the Free/Pedunculated Flap in Total Laryngectomy After (Chemo-)Radiotherapy Failure for Laryngeal Carcinoma: Impact on the Risk of Pharyngocutaneous Fistula (PCF)

Multicenter, prospective, randomized study aimed at evaluating the difference in risk of PCF after salvage laryngectomy in two groups of patients: one cohort treated with Total Laryngectomy (LT) with primary suture, a second group treated with LT and reinforcement by flap positioning with onlay technique (PMM, ALT)

Inclusion Criteria: * Histological confirmation of recurrence/persistence of squamous cell carcinoma of the larynx previously subjected to exclusive radiotherapy or concomitant chemo-radiotherapy treatment: 1. pre (ChT-)RT staging: cT1/T2/T3 N0/N+; 2. pre STL staging: rcT1/cT2/ Selected cT3 cT4a (extension to thyroid cartilage and/or prelaryngeal tissues) N0/N+ (clinically and radiologically). * Indication for STL surgery (no pharyngeal mucosal resection); * Functional total laryngectomies after radical (chemo-)radiotherapy treatment; * Age \> 18 years; * Signature of informed consent and ability to complete in-office questionnaires. Exclusion Criteria: * STL extended to the pharynx and/or total pharyngeal laryngectomies; * Extension of the tumor to the pharyngeal mucosa and/or massive extra-laryngeal extension; * Previous open organ preservation surgery (OPHL).