Complications and predisposing factors from a decade of total laryngectomy

Abstract

BackgroundTotal laryngectomy is often utilised to manage squamous cell carcinoma of the larynx or hypopharynx. This study reports on surgical trends and outcomes over a 10-year period.MethodA retrospective review of patients undergoing total laryngectomy for squamous cell carcinoma was performed (n = 173), dividing patients into primary and salvage total laryngectomy cohorts.ResultsA shift towards organ-sparing management was observed. Primary total laryngectomy was performed for locoregionally advanced disease and utilised reconstruction less than salvage total laryngectomy. Overall, 11 per cent of patients developed pharyngocutaneous fistulae (primary: 6 per cent; salvage: 20 per cent) and 11 per cent neopharyngeal stenosis (primary: 9 per cent; salvage: 15 per cent). Pharyngocutaneous fistulae rates were higher in the reconstructed primary total laryngectomy group (24 per cent; 4 of 17), compared with primary closure (3 per cent; 3 of 90) (p = 0.02). Patients were significantly more likely to develop neopharyngeal stenosis following pharyngocutaneous fistulae in salvage total laryngectomy (p = 0.01) and reconstruction in primary total laryngectomy (p = 0.02). Pre-operative haemoglobin level and adjuvant treatment failed to predict pharyngocutaneous fistulae development.ConclusionComplications remain hard to predict and there are continuing causes of morbidity. Additionally, prior treatment continues to affect surgical outcomes.

Screening of co-expressed genes in hypopharyngeal carcinoma with esophageal carcinoma based on RNA sequencing and Clinical Research

“…According to the recommendations of the guidelines for the diagnosis and treatment of multiple primary cancers of the hypopharynx-esophagus 4 , for patients with synchronous hypopharyngeal carcinoma combined with esophageal carcinoma, the comprehensive treatment model of surgical treatment followed by postoperative chemoradiotherapy is an ideal treatment method. However, the complications of surgical treatment, such as gastric emptying dysfunction, gastroesophageal anastomotic leakage, anastomotic stenosis, or pleural effusion, seriously affect the quality of life of patients 5 . For patients with metachronous hypopharyngeal carcinoma combined with esophageal carcinoma, the treatment options for secondary carcinoma are always limited by thetreatment of the first primary carcinoma, resulting in long treatment cycles andpoor efficacy for patients.…”

Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer

“…Total laryngectomy followed by adjuvant radiation therapy (RT) +/− chemotherapy plays an important role in the management of locally advanced laryngeal and hypopharyngeal cancers. However, some patients decide to forgo laryngectomy due to morbidities 2–4 . In the last several decades, studies have advocated for larynx preservation as an alternative treatment with comparable outcomes.…”

“…However, some patients decide to forgo laryngectomy due to morbidities. [2][3][4] In the last several decades, studies have advocated for larynx preservation as an alternative treatment with comparable outcomes.…”

Transgastrostomy retrograde endoscopic submucosal dissection of esophageal squamous cell carcinoma

“…Patients undergoing treatment for laryngeal cancer are often treated with total laryngectomy, with about 11 % of patients developing a postoperative stricture [1]. Patients with head and neck tumors also develop esophageal squamous cell carcinoma (ESCC) in 5 %-10 % of cases [2].…”