Functional results of pharyngo-laryngectomy and total laryngectomy: a comparison

Abstract

The additional measures involved in pharyngo-laryngectomy do not confer any functional disadvantage, compared with total laryngectomy, but only if the procedure is non-circumferential. Functional results of circumferential pharyngo-laryngectomy are worse than those of both non-circumferential pharyngo-laryngectomy and total laryngectomy. If oncologically possible and safe, it is better to keep a pharyngo-laryngectomy non-circumferential.

Clinical and functional outcomes after total laryngectomy and laryngopharyngectomy: Analysis by tumor subsite, salvage status, and extent of resection

“…Few studies have attempted to investigate the effects of prior XRT on functional outcomes in laryngeal and hypopharyngeal SCC patients undergoing surgical intervention. Gadepalli et al did not find a significant difference in postoperative functional outcomes when stratifying by salvage status. However, the authors acknowledged that their laryngopharyngectomy group had a relatively low proportion of salvage patients (20%).…”

Pharyngocutaneous fistula and delay in free oral feeding after pharyngolaryngectomy for hypopharyngeal cancer

“…As for the association between pharyngocutaneous fistula and oral feeding, a recent study of 191 patients with head and neck cancer who had undergone microvascular reconstruction showed that defects of the hypopharynx and radiotherapy before surgery strongly predicted postoperative difficulty in swallowing, as assessed by whether patients were eventually able to take food orally or remained dependent on nasogastric tubes . In addition, merely the presence of a pharyngocutaneous fistula is known to independently impair swallowing outcome . We found that in patients who undergo a pharyngolaryngectomy, pharyngocutaneous fistulas resulted in delayed starting of postoperative oral feeding: these patients took more than 3‐fold longer than patients without pharyngocutaneous fistulas to initiate free oral feeding.…”

“…Additional resection of pharyngeal mucosa significantly increases the incidence of pharyngocutaneous fistula formation after total laryngectomy. 17,18 However, relatively few studies have reported the incidence of postoperative pharyngocutaneous fistula after pharyngolaryngectomy: 5.0% (6 of 119), 19 22% (12 of 55), 11 30.6% (15 of 49), 20 and 52.5% (52 of 160). 4 In our study, we found a relatively low proportion (6%) of fistulas after pharyngolaryngectomy, surgical closure of pharyngocutaneous fistulas having been performed in 3.4% of the patients.…”

“…Numerous studies have reported the risk of fistula formation after total laryngectomy and the appropriate timing for recommencing oral feeding after total laryngectomy . However, only a few studies have addressed the risk of pharyngocutaneous fistula formation after pharyngolaryngectomy . Further, to our knowledge, there is a lack of data on the interval from pharyngolaryngectomy to free oral feeding in patients with hypopharyngeal cancer and little is known about factors affecting this interval.…”

“…8 However, only a few studies have addressed the risk of pharyngocutaneous fistula formation after pharyngolaryngectomy. [9][10][11] Further, to our knowledge, there is a lack of data on the interval from pharyngolaryngectomy to free oral feeding in patients with hypopharyngeal cancer and little is known about factors affecting this interval.…”