Complications and Pre-disposing Factors from a Decade of Total Laryngectomy

Introduction
Total Laryngectomy is often utilised to manage Squamous Cell Carcinoma of the larynx/hypopharynx. We report surgical trends and outcomes over a 10-year period.
Methods
A retrospective review of patients undergoing total laryngectomy for squamous cell carcinoma was performed (n=173), dividing patients into Primary (PTL) and Salvage (STL) cohorts.
Results
A shift towards organ-sparing management was observed. PTL was performed for locoregionally advanced disease and utilised reconstruction less than STL.

Overall, 11% of patients developed pharyngo-cutaneous fistula (6%/20% in PTL/STL) and 11% neo-pharyngeal stenosis (9%/15% in PTL/STL). pharyngo-cutaneous fistula rates were higher in the reconstructed PTL group (24%, 4/17), compared with primary closure (3%, 3/90), (p=0.02). Patients were significantly more likely to develop neo-pharyngeal stenosis following pharyngo-cutaneous fistula in STL (p=0.01) and reconstruction in PTL (p=0.02). Pre-operative haemaglobin and adjuvant treatment failed to predict pharyngo-cutaneous fistula development.
Conclusions
Complications remain hard to predict and are continuing causes of morbidity. Additionally, prior treatment continues to have an effect on surgical outcomes.