Laryngeal Cancer: Long-Term FolIow-Up of Respiratory Functions after Laryngectomy

Abstract

Pulmonary function of 31 heavy smokers with laryngeal cancer was evaluated before and during the 1st year after total (n = 21) and conservative (n = 10) laryngectomy. 2 of them died because of recurrences, 1 for bronchopulmonary complications. Long-lasting hoarseness was the only presenting symptom in all patients. Preoperative lung function data and mucociliary clearance were consistent with a coexisting chronic obstructive lung disease in most subjects and was probably due to smoking. No differences were observed comparing pre- and postoperative data in the 10 conservative laryngectomy patients. On the contrary, the total-laryngectomy patients showed a progressive impairment of bronchial obstruction and bacteriological infection of the trachea during the 1st year after the operation. An impressive increase in mucociliary clearance rates has been observed 2 months after total laryngectomy during the postoperative hypersecretory phase. The obtained data allow us to hypothesize that when clinical conditions of laryngectomized patients in whom local or distant recurrences have been excluded deteriorate, this is related to a progressive bronchial obstruction at any level of the bronchial tree due to descending bacterial infection of the airways. To our knowledge this is the only work demonstrating that total laryngectomized patients need a complete pre- and postoperative evaluation of lung function, airway dynamics, mucociliary function and tracheal bacteriology for long-term prognosis and treatment.

Evaluation of Direct and Indirect Methods of Sub-Neoglottic Pressure Measurement in Tracheoesophageal Speakers: A Systematic Review and Meta-Analysis

“…This difference can be due to changes in the respiratory system (reduced vital capacity; functional residual capacity, and mean expiratory flow rate), change in source of vibration (glottis to neoglottis) following total laryngectomy, change in vibrating principles (mass, length, and tension), and respiratory compromise due to typical age-related changes (loss of elasticity; recoil forces and reduced muscular forces) [14,[35][36][37][38][39][40][41][42]. Hence, SNP values obtained from the direct and indirect measurement methods in TE speakers may not be comparable with SGP obtained from normal laryngeal speakers.…”

Effectiveness of Bronchodilator Therapy on Dyspnoea After Total Laryngectomy

“…4,5 After the risk of developing a second cancer, the second leading cause of morbidity and mortality in these patients is the progressive deterioration of lung function 6 until respiratory failure occurs.…”

Validação de metodologia de avaliação da função pulmonar em pacientes submetidos à laringectomia total

“…Além disso, o ar inalado não passa por umidificação nem por aquecimento. Comparando com a respiração através do trato respiratório superior, o paciente traqueostomizado tem uma redução aerodinâmica na resistência ao fluxo aéreo durante a inspiração e a expiração, o que pode ter um efeito negativo na ventilação pulmonar periférica (colabamento alveolar) em função de uma alteração do ponto de igual pressão (ponto no qual a pressão intrapleural e a pressão alveolar são iguais) [4][5][6][7] .…”

“…Um dos fatores prognósticos mais importantes na sobrevida de pacientes laringectomizados é a deterioração progressiva de sua função pulmonar 5,8 . Entretanto, são escassas as informações objetivas acerca das condições respiratórias em laringectomizados, obtidas em laboratórios para avaliação da função pulmonar, 2,5,[9][10][11] .…”

“…Tradicionalmente, uma cânula traqueal com balonete conectada ao espirômetro tem sido usada para avaliação da função pulmonar nesses pacientes 5,12,16 . Entretanto, o uso de uma cânula é problemático por algumas razões.…”