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CION Cancer Clinics
Total laryngopharyngectomy: what is actually removed | CION Cancer Clinics
A total laryngopharyngectomy removes the whole voice box and the whole of the lower throat behind it, and usually the lymph nodes in the neck. Sometimes part of the thyroid gland or the top of the food pipe goes too. A new swallowing tube is built from tissue elsewhere in your body, and you breathe through a permanent opening in the neck. This page walks through each part in plain words. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What exactly is removed in a total laryngopharyngectomy?
- What did each removed part do, and what replaces it?
- What happens during the operation, in order?
- What do the words on the operation note mean?
- What changes after the operation?
- What do families believe about this operation that is not true?
- Who does this operation not suit?
- Common questions about what is removed
The short answer
What exactly is removed in a total laryngopharyngectomy?
A total laryngopharyngectomy removes the whole voice box (the larynx) and the whole lower throat behind it (the pharynx, the passage that carries food down to the food pipe). The lymph nodes in the neck are usually taken too, and sometimes part of the thyroid gland.
Why both parts go together
The voice box and the lower throat share a wall. A cancer in one often grows into the other, so it cannot be cut out cleanly while leaving either behind. Removing both gives a clear margin, meaning a rim of healthy tissue all round the cancer with no cancer cells at the edge.
What has to be rebuilt
With the throat gone, the surgeon makes a new swallowing tube. It may be a rolled piece of skin from the thigh or forearm, a short length of small bowel, or the stomach pulled up into the neck if the food pipe was removed too.
How the team knows how much to take
The plan comes from the scans, a look down the throat under anaesthetic, and the biopsy. Together they show where the cancer starts and stops. The final extent is sometimes only clear once the neck is open.
This page describes what is removed. It cannot tell you whether this operation is right for you. That decision sits with your treating team.Part by part
What did each removed part do, and what replaces it?
The voice box (larynx)
It made your voice and guarded the windpipe when you swallowed. The windpipe is brought out to an opening in the front of the neck, called a stoma, and you breathe through it for life.
What replaces it
- A stoma for breathing
- A new way to speak
The lower throat (pharynx)
The passage between the back of the mouth and the food pipe. It is rebuilt with tissue from elsewhere in your body so food has a route down again.
Neck lymph nodes
Small glands where throat cancers spread first. Removing them lets the pathologist check each one, which tells the team the stage, meaning how far the cancer has gone.
The thyroid gland
It sits against the windpipe, so half or all of it is sometimes removed. If all of it goes, you take a thyroid tablet every day.
Not sure whether this applies to you?
Ask an oncologistIn the operating theatre
What happens during the operation, in order?
-
A long anaesthetic
You are fully asleep throughout. This is a long operation, and your family should expect to wait most of the day.
-
The neck nodes are cleared
A cut runs across the front of the neck. The lymph nodes come out first, so the surgeon can see the main blood vessels and nerves.
-
The voice box and throat come out together
They are freed from the tissue around them and removed in one piece. If the cancer reaches the food pipe, part of that goes too.
-
The edges are checked
Pieces from the cut edges go to the laboratory while you are still asleep. If cancer is found at an edge, a little more is taken.
-
The new tube is built and the stoma made
The planned reconstruction is joined in place, a feeding tube is placed, and the windpipe is stitched to the skin of the neck. You wake up in intensive care.
On your report
What do the words on the operation note mean?
- Hypopharynx
- The lowest part of the throat, beside and behind the voice box. Most of these operations are for cancer that started here.
- Pharyngo-oesophagectomy
- The food pipe was removed along with the throat, usually replaced by the stomach pulled up into the neck.
- Circumferential defect
- The whole ring of the throat was removed, so a complete new tube had to be built.
- Stoma
- The permanent breathing opening in the neck. It is not a tracheostomy, which is temporary and leaves the voice box in place.
- Neck dissection
- Removal of the lymph nodes from one or both sides of the neck. The report says how many contained cancer.
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Side by side
What changes after the operation?
Before the operation
After the operation
Breathing through the nose and mouth
Breathing only through the stoma in the neck
Natural voice from the voice box
A new voice, using a valve, a device or learned throat speech
Food and air share the throat, so choking is possible
Food and air take separate routes, so food cannot enter the lungs
Smell works normally
Smell is weaker because air no longer passes the nose
Bathing without thought
The stoma must be shielded from water
Commonly believed
What do families believe about this operation that is not true?
"He will never be able to speak again."
Almost everyone finds a way to speak. A small valve between the windpipe and the new throat lets many people talk in a low, clear voice. Others use a hand-held device. It is a different voice, not silence.
"The hole in the neck will close up in time."
It will not, and it must not. The stoma is your only airway once the voice box is gone. Knowing this before the operation helps the whole family prepare.
"They took out more than they needed to."
Surgeons remove what is needed for a clear edge, and check it in the laboratory during the operation. Leaving cancer behind would mean a harder second operation in scarred tissue.
"He will be fed through a tube for life."
The tube is for the weeks while the new throat heals. Most people eat by mouth again, often softer food and slower meals. A few need the tube longer, and the team will say so honestly.
Being straight with you
Who does this operation not suit?
This operation is not offered to everyone with a throat or voice box cancer. Many earlier cancers are treated with radiotherapy, with or without chemotherapy, and the voice box is kept. Surgery is usually for cancers too large for that, or that return after radiotherapy.
When it is often not the right choice
When the heart or lungs would not cope with a long anaesthetic. When the cancer has already spread to distant organs. When a person, having understood what a stoma means, decides they do not want one. Each is a discussion, not a rule, and the team weighs your scans, fitness and wishes together.
What this page cannot tell you
It cannot tell you how the cancer will behave, how long your recovery will take, or whether you need radiotherapy afterwards. Those answers come from the pathology report on what was removed.
What to ask before you agree
Ask which parts will be removed and which will be kept. Ask what the new swallowing tube will be made from, and why that choice. Ask whether radiotherapy alone was considered, and what the team expects your speech and eating to be like a few months later.
Ask the team to draw what will be removed. Most surgeons will.Questions we are asked
Common questions about what is removed
Is this the same as a laryngectomy?
No. A total laryngectomy removes the voice box alone and leaves the throat, which can usually be stitched closed. A laryngopharyngectomy removes the throat as well, so it needs tissue from elsewhere to rebuild the swallowing tube. Recovery is longer and a leak at the join is more likely.
Will the food pipe be removed too?
Only if the cancer reaches into it or a clear edge cannot be found above it. Then the stomach is usually pulled up to replace the whole length. Your surgeon can often say beforehand whether this is likely, though sometimes it is decided in theatre.
Why remove the lymph nodes if the scan was clear?
Scans can miss very small deposits. Throat cancers spread to the neck nodes early, so most surgeons remove them and the pathologist checks each one. The result helps decide whether you need radiotherapy afterwards.
Will I be able to eat normally again?
Most people eat by mouth again, but usually slower and softer food than before, after weeks of practice with a swallowing therapist. Some foods stick in the new tube. A few people need a feeding tube for longer, especially if the join narrows.
Can the thyroid be saved?
Often at least half of it. The surgeon keeps whatever is safely clear of the cancer. If it all goes, a daily tablet replaces its hormone. Calcium is checked in the first days, because the small glands that control it sit behind the thyroid.
How big will the scar be?
There is a scar across the front of the neck, plus the stoma. If tissue is taken from the thigh or forearm for the new throat, there is a second scar there. Neck scars usually fade to a pale line over time.
Does everyone need radiotherapy afterwards?
No. It depends on the pathology report: whether the edges were clear and how many nodes held cancer. If you had radiotherapy before, it usually cannot be repeated on the same area. The tumour board decides once the report is back.
Should we get a second opinion first?
For an operation this size, it is reasonable, and a good surgeon will not be offended. Take the biopsy report, scans and written plan. Ask whether they would recommend the same operation, and if not, why. Call the helpline if you want help arranging one.
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Sources
- Cancer Research UK — Laryngeal cancer
- NHS — Laryngeal (larynx) cancer
- National Cancer Institute — Hypopharyngeal cancer treatment (PDQ), patient version
- Macmillan Cancer Support — Head and neck cancer
- American Cancer Society — Laryngeal and hypopharyngeal cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
When the Food Pipe Must Be Removed With the Voice BoxThe situations where the operation reaches lowerGastric Pull-Up ReconstructionHow the stomach replaces the throat and food pipeVoice After LaryngopharyngectomyThe ways people speak againDeciding on Cancer SurgeryWhat the team weighs and what to askRecovery and Hospital StayWhat the weeks after look like
Talk to us
Been told the voice box and throat need to come out?
Send us the biopsy report and scans, or call the helpline. A surgical oncologist will explain what is being proposed, why, and what the alternatives are. One helpline serves every CION centre.