Complications following surgery for cancer of the larynx and pyriform fossa

Abstract

The hospital records of patients undergoing major surgery for cancer of the larynx and hypopharynx at the Tata Memorial Hospital, Bombay, from 1981 to 1985 were reviewed. Different variables were correlated with the incidence of major complications and were analysed to find out significant factors contributing to increased complication rates. Complications included wound infection, pharyngocutaneous fistulae, flap necrosis, carotid blowout, and neo-esophageal stenosis. Postoperative deaths and delayed fatalities were also recorded. The overall fistulae rate was 34.7%, and wound infection occurred in 28% of patients. Prior radiotherapy and the need for pharyngeal reconstruction were found to be significant in determining postsurgical complications. Age, sex, site, stage, cartilage and soft tissue infiltration, preoperative tracheostomy, involvement of resection margins by tumor, and the dose of radiotherapy were not found to influence the complication rates.

Post-operative pharyngocutaneous fistula after laryngectomy

“…Some retrospective studies have reported an increased incidence of wound and systemic complications for salvage laryngectomy after RT or CRT (9,10,11,12).…”

“…Sarkar et al reported that prior irradiation significantly affected the incidence of PCF, 58% for irradiated patients and 21% for non-irradiated patients, respectively (12). A meta-analysis of post-laryngectomy PCF showed that pre-operative radiotherapy increased the risk of PCF formation, and the severity and duration of fistula were greater than those without pre-operative radiotherapy (14).…”

Comparison of Surgical Complications After Organ-Preservation Therapy in Patients With Stage III or IV Squamous Cell Head and Neck Cancer

“…1 Adjuvant and neoadjuvant chemotherapy has been added to various multimodality approaches. [1][2][3][4][5][6][7] Concurrent chemotherapy and radiation therapy has also been proposed. [8][9][10] Advantages of this approach include the independent antineoplastic activity of both treatments, the radiotherapeutic potentiation exerted by several chemotherapeutic agents, the possibility that systemic chemotherapy may decrease micrometastatic spread, and the relatively short duration of therapy.…”

“…8 Although these aggressive organ preservation protocols have produced encouraging results, an increased incidence of surgical complications in patients who require surgery for persistent or recurrent disease has been reported. Curative radiotherapy and induction chemotherapy followed by definitive radiotherapy result in complication rates for salvage operations of 37% to 74% [2][3][4][5]11 and 46% to 100%, 6,7,12,13 respectively. Induction chemotherapy and chemoradiotherapy for organ preservation are used with the primary goal being the elimination of extensive surgery in hopes of maintaining normal speech and swallowing.…”

“…[2][3][4] Complication rates for surgical salvage operations of 37%, 43%, 58%, and 74% have been reported. [2][3][4][5] Radiation dose of more than 50 Gy has been implicated, and some recent reports suggest that doses of 66.5 Gy and higher increase complication rates.…”