A 59-year-old man from Massachusetts has become the first known person to have received a total larynx transplant whilst having active cancer. Patient Marty Kedian has joined a very short list of people who’ve undergone this surgery in the past, with surgeons at the Mayo Clinic in Arizona hoping the procedure could soon be offered to more people who have lost their voices to cancer.

Sometimes called the “voice box”, the larynx is a small, tubular structure that sits above the trachea and in front of the esophagus. It has a number of important functions, containing both the vocal cords that give sound to the human voice and the epiglottis that prevents food and liquid from entering the trachea.

Dysfunction of the larynx can result from injury, and surgery to remove it may be needed in cases of laryngeal cancer. This can have life-altering consequences, as the medical team behind the recent surgery explained in their case report: “These patients may be tracheostomy tube dependent, gastrostomy tube dependent, and may lose their ability to verbally communicate.”

A laryngeal transplant could be the solution, but the operation is tricky to perform and the results are difficult to predict. For that reason, only a handful of people around the world have undergone this surgery, just two of whom were in the US – one in 1998 and one in 2012.

A team at the Mayo Clinic is now conducting a clinical trial to better explore the potential of this surgery. Kedian was the first patient, receiving his transplant on February 29, 2024. His case differs from the two previous US cases in one major way – he had cancer, whereas both previous transplant recipients had suffered laryngeal injury.

Kedian had had several procedures to try and remove the cancer and preserve the function of his larynx, but these had left him with difficulty speaking and swallowing, and he required a tracheostomy tube. 

One of the concerns with performing this transplant in cancer patients is the need to take anti-rejection medication afterward. As these medicines dampen the immune system, there’s a risk of the cancer coming back. In Kedian’s case, though, there was a point in his favor – he was already taking immunosuppressants after a kidney transplant, and it was judged they wouldn’t have an impact on the type of laryngeal cancer he had, a chondrosarcoma.

It took 10 months of waiting before a donor larynx of the correct size became available, and then the transplant was accomplished by a team of surgeons in a 21-hour procedure. Pioneering microsurgery was used to reconnect the nerves that help control swallowing and vocal cord movement.

Three weeks after the procedure, Kedian was able to say his first word: “hello.” He has since relearned to swallow, and his speech continues to improve. 

“Every day it's getting better,” he told AP. “I'm pushing myself to make it go faster because I want these tubes out of me, to go back to a normal life.”

From the time he was first diagnosed with laryngeal cancer, Kedian was fearful of losing his voice. “I love to talk to people everywhere I go, and I just couldn't. I felt strange, and I wouldn't go out anywhere,” he said in a statement. 

“I wanted this so I could talk and breathe normally with my new granddaughter. I want to read her bedtime stories with my own voice.”

While overall a fairly rare cancer type, with 184,615 global cases in 2020, laryngeal cancer is the biggest cause of damage leading to larynx removal. For the surgical team, transplants offer the hope of a much-improved quality of life for their patients.

“People need to keep their voice,” Kedian told AP. “I want people to know this can be done.”

The study is published in the journal Mayo Clinic Proceedings.