Abstract
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.
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.
Original language | English |
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Journal | Journal of Laryngology and Otology |
Volume | 134 |
Issue number | 3 |
Early online date | 21 Feb 2020 |
DOIs | |
Publication status | Published - Mar 2020 |