Preoperative prognostic factors for functional and clinical outcomes after open partial horizontal laryngectomies

Abstract

Background In minority of cases, the clinical recovery of the neolarynx after open partial horizontal laryngectomies (OPHLs) can be challenging, possibly affecting the final functional outcome. Methods One hundred and twenty‐three patients who underwent OPHLs were selected. A series of clinical preoperative independent variables were considered. All patients were monitored for the following dependent outcome variables: sequelae; need for percutaneous endoscopic gastrostomy positioning; days before tracheal cannula removal and nasogastric tube removal; and length of hospital stay. Univariate and multivariate logistic regression analyses were performed to identify significant associations between preoperative clinical variables and outcomes variables. Results Multivariate analysis confirmed age, cT classification, body mass index, and smoking habits as significant prognostic factors for worse functional and clinical recovery outcomes. Conclusions Knowing what variables are significantly associated with worse clinical and functional outcomes can guide clinicians in defining the best surgical choice not only from an oncological perspective, but also for a better postoperative recovery.

Clinical Implications of Larynge Cancer

“…25 The conservative surgeries that are represented by Open Horizontal Partial Laryngectomies (OPHLs) are treatment approaches that can be used in the early stages and in some advanced stages, up to stage T4a on a selected basis. 26,27 OPHLs represent safe oncological procedures and, as reported by several authors, have an excellent overall survival, disease-free survival, and TL-free survival. 26 A retrospective study made it possible to verify that the recovery of the main laryngeal functions (swallowing, breathing and voice) is satisfactory, after performing OPHLs as the first choice method.…”

“…26,27 OPHLs represent safe oncological procedures and, as reported by several authors, have an excellent overall survival, disease-free survival, and TL-free survival. 26 A retrospective study made it possible to verify that the recovery of the main laryngeal functions (swallowing, breathing and voice) is satisfactory, after performing OPHLs as the first choice method. 26 Mainly in type I OPHLs, a method in which the vocal folds are spared, in subtypes II and III there is a high deterioration of this structure.…”

“…26 A retrospective study made it possible to verify that the recovery of the main laryngeal functions (swallowing, breathing and voice) is satisfactory, after performing OPHLs as the first choice method. 26 Mainly in type I OPHLs, a method in which the vocal folds are spared, in subtypes II and III there is a high deterioration of this structure. 26 Another function that is largely affected by OPHLs is swallowing, in most cases the dysfunction resolves within six months, however aspiration may persist, leading to an increased risk of pneumonia and death.…”

“…26 Mainly in type I OPHLs, a method in which the vocal folds are spared, in subtypes II and III there is a high deterioration of this structure. 26 Another function that is largely affected by OPHLs is swallowing, in most cases the dysfunction resolves within six months, however aspiration may persist, leading to an increased risk of pneumonia and death. 26 Supracricoid laryngectomy (SCL) has recently been included in Type II OPHLs.…”

Oncological Outcomes of Primary vs. Salvage OPHL Type II: A Systematic Review

“…According to some authors, in fact, advanced age does not represent a contraindication to the intervention of OPHL type II [6] due to the difference between biological and chronological age [31]. According to other authors, however, advanced age correlates with a worse functional and clinical outcome [39]. Furthermore, Lucioni et al [40] indicated young age as a negative prognostic factor, probably due to the increased aggressiveness of the tumor.…”