Complications of total laryngectomy in the era of chemoradiation

Abstract

As more total laryngectomies (TLE) are nowadays performed as salvage procedures, the rate of postoperative complications increases. The primary aim was to report the rates of postoperative local complications for total laryngectomy in patients with previous radiotherapy or chemoradiotherapy (RT/CRT) in comparison with primary TLE data. We attempted to identify patient-and tumor-related factors predictive of postoperative pharyngocutaneous Wstula (PCF) formation. The secondary aims were to analyze the survival rate in relation to postoperative complications and to study prognostic factors of survival in TLE patients. A retrospective study was conducted in 208 patients. Logistic regression was used to determine the most signiWcant risk factors for Wstula formation. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox multivariate regression. PCF developed in 20.7% of cases. In the group of patients with previous RT/CRT, the Wstula rate was signiWcantly higher (34%). In multivariate analysis, signiWcant risk factors for Wstula formation were previous radiotherapy or chemoradiotherapy (p = 0.02), higher N classiWcation (p = 0.03), and procedure performed by a less experienced surgeon (p = 0.003). The survival and recurrence rates were not inXuenced by PCF formation. The overall survival rates were lower in patients with previous RT/CRT and in patients with lymph node involvement.

Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking

“…The incidence of PCF was 31% in patients with diabetes and 19.4% in non-diabetics (p=0.302); other additional comorbidities such as chronic pulmonary disease and advanced age were not also found to be related to PCF formation in our study, which is different from what was found in some reports (6,15,29,30). Likewise our study, Akduman et al (31) did not detect any significant relationship between the presence of chronic systemic disease and formation of PCF.…”

“…In our study, we demonstrated an increased incidence of PCF in patients with preoperative RT, which is in agreement with the majority of literature reports (13)(14)(15)(16)(17)(18)(19)(20). While, some studies did not find any association between preoperative RT and PCF formation (5-7, 21, 22).…”

“…Overall and local-regional recurrence-free 3-and 5-year survival rates were statistically insignificant between the PCF and non-PCF groups and also between the salvage and primary surgery groups in our study, which is similar to what was found in previous reports (15,22). However, the overall 5-year survival rate was statistically less in the persistent PCF group (46%) than in the non-persistent PCF group (83%) (p=0.038).…”

Salvage surgery after local recurrence in patients with head and neck carcinoma treated with chemoradiotherapy or bioradiotherapy

“…While some authors have found that the complication rate for salvage surgery after chemoradiotherapy is higher than that after radiotherapy alone [7][8][9], others report no significant differences [10][11][12].…”

Laringectomía total ampliada en carcinoma laríngeo avanzado T4a

“…Las opciones quirúrgicas para tumores T1 y T2 incluyen resección de cuerda vocal, microcirugía láser transoral, hemilaringectomía y laringectomía subtotal. Se obtienen benefi cios con el tratamiento quirúrgico tales como la extirpación tumoral (R0) y reserva de otros tratamientos, como la radioterapia sólo en caso de recurrencias 4,13 . La laringectomía total en general se reserva para el cáncer laríngeo más avanzado (T3 y T4) o para pacientes con mala respuesta a tratamientos previos y para aquellos sometidos a una cirugía conservadora de órganos con pobres resultados funcionales en cuanto a fonación y/o deglución 14 .…”