Evaluation of risk factors for stomal recurrence after total laryngectomy

Abstract

The development of a stomal recurrence after total laryngectomy is a complication with a dismal prognosis. The risk factors and mechanisms involved are still not well understood. In this review of 352 patients, 21 (6%) developed a stomal recurrence. We studied the group of 74 patients (21%) with subglottic involvement separately. There was no significant difference in the rate of stomal recurrence in those with emergency tracheostomy (23.3%) as compared with those with intra-operative tracheostomy (18.2%). Stomal recurrence was more strongly associated with subglottic involvement itself (20.3%) and T4 stage (15.3%). The findings suggest that submucosal extension and lymph node metastases are probably more important mechanisms of stomal recurrence than cancer cell implantation.

Recorrência na área do traqueostoma após laringectomia total

“…In the many series, the recurrence incidence in the tracheostoma area varies between 1.7% and 25% 2,3 , and in our study we report an incidence of 10.6%.…”

“…The true rates are unknown because many series reported in the literature classify the recurrence in the tracheostoma area as part of local recurrences 3 . Another problem found is the large number of synonyms used to define this type of pathology, such as: tracheal metastasis, peritracheal recurrence, tracheal recurrence, paratracheostomal tumor persistence, tracheostomal metastasis, and second primary tumor in the trachea 3 .…”

“…Another problem found is the large number of synonyms used to define this type of pathology, such as: tracheal metastasis, peritracheal recurrence, tracheal recurrence, paratracheostomal tumor persistence, tracheostomal metastasis, and second primary tumor in the trachea 3 . Most of these recurrences are diagnosed in the first year after total laryngectomy12.…”

“…Nonetheless, there is great difficulty in knowing the real value of such recurrence rates, since many papers include them in the local recurrence group 2,3 . Another significant factor that may cause difficulties in analyzing recurrence incidence in the tracheostoma area is the number of synonyms used to describe such pathology, such as: tracheal metastasis, peritracheal recurrence, tracheal recurrence, paratracheostomal tumor, tracheostomal metastasis, second primary tumor in the trachea 3 . Most relapses in the tracheostoma area are diagnosed in the first year after total laryngectomy and its pathogeny is still not clearly defined 1,[4][5][6][7] .…”

“…Many methods have been proposed to prevent recurrence in the tracheostoma area, such as: lower trachea section allowing for a broader surgical margin, dissection of lymphnodes located in the paratracheal chains, emergency laryngectomies in patients that required tracheostomy prior to their laryngectomy, postoperative radiotherapy including the tracheostoma and the upper mediastinum 1,3,7,11 . Historically, recurrences in the tracheostoma area are considered very difficult to treat and are associated to little likelihood of survival 10,[12][13][14][15] .…”