Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

Abstract

Summary The goal of this study was to identify host and tumour factors associated with postoperative pneumonia (PP) in a selected population of laryngeal cancer patients, treated by partial laryngectomy in 20 years at our Institution and to assess its potential prognostic impact. Clinical records of 416 consecutive patients were retrospectively reviewed. Tobacco consumption, body mass index (BMI), previous pulmonary disease, age, sex, preoperative blood gas analysis values, tumour stage and type of surgery were tested as potential risk factors for PP. Finally, the prognostic impact of these variables, including PP, in terms of disease-free and actuarial survival by Kaplan-Meier and Cox analyses were evaluated. PP developed in 73 patients (16.8%). We identified two groups of patients: 26 patients experienced an early PP within the first 7-9 days after surgery, whilst 44 experienced an ab ingestis PP following attempts of oral food intake restoration, three patients died for PP related sepsis. At multivariate Cox analysis, age older than 60 years and BMI greater than 30 were statistically associated with early PP; whereas male gender and laryngectomy with neck dissection were statistically related to a higher risk of ab ingestis PP. Interestingly, the occurrence of early PP was a negative independent prognostic factor for 5-years disease-free and actuarial survival (p = 0.049 and p = 0.001, respectively). The occurrence of early-onset pneumonia in laryngeal cancer patients selected for conservative laryngectomies is predictable and associated with poor clinical outcome.

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

“…21,22 Conversely, neck dissection during salvage laryngeal cancer was associated with an increased rate of postoperative complications (71.4 per cent in the neck dissection group vs 26.8 per cent in the 'wait-and-see' group, p = 0.02), especially pharyngocutaneous fistulas (Table II; 57.2 per cent), as previously reported. [22][23][24] These discrepancies suggest a selection bias toward treating RT-recurrent laryngeal carcinoma patients with salvage laryngeal surgery and concomitant neck dissection, and a possible negative impact of uni-or bilateral neck procedures on devascularised irradiated soft neck tissue, associated with a higher risk of locoregional complications, especially pharyngocutaneous fistulas.…”

Nomograms for prediction of postoperative complications in open partial laryngeal surgery

“…Pneumonia in the postoperative setting cannot just be considered as a simple infectious complication . Despite preoperative patients’ selection, routine antibiotic prophylaxis and carefully performing a tracheotomy, such complication is often unavoidable.…”

“…Old age (more than 60‐year old) and a body mass index greater than 30 kg/m 2 are known risk factors to develop it. Interestingly, early onset pneumonia (occurring even before the first exercise to restore oral intake) has been associated with a negative outcome in terms of 5‐year disease‐free and overall survival …”

“…42,43 Pneumonia in the postoperative setting cannot just be considered as a simple infectious complication. 44 Despite preoperative patients' selection, routine antibiotic prophylaxis and carefully performing a tracheotomy, such complication is often unavoidable. Old age (more than 60-year old) and a body mass index greater than 30 kg/m 2 are known risk factors to develop it.…”

Dysphagia Evaluation and Treatment After Head and Neck Surgery and/or Chemo-radiotherapy for Head and Neck Malignancies

“…In many of the patients with head and neck cancer, dysphagia as well as its complications (malnutrition and aspiration pneumonia), are commonly found and significantly impact on health and quality of life (QOL) (Gallo et al 2009;Manikantan et al 2009;Schindler et al 2006). Different factors may contribute to the presence of dysphagia: the tumor itself, the treatment and, in a small percentage of patients, associated diseases, such as Parkinson's or stroke.…”