Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx

Farlow, Janice L.; Birkeland, Andrew C.; Hardenbergh, Anna; Lyden, Teresa; Brenner, J. Chad; Shuman, Andrew G.; Chinn, Steven B.; Stucken, Chaz L.; Malloy, Kelly M.; Moyer, Jeffrey S.; Casper, Keith; Prince, Mark E.; Bradford, Carol R.; Wolf, Gregory T.; Chepeha, Douglas B.; Rosko, Andrew J.; Spector, Matthew E.

doi:10.1007/s00405-020-05809-y

Cited by 13 publications

(25 citation statements)

References 17 publications

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“…We report surgical outcomes of laryngectomy that are comparable to those reported previously. 6-9 With 100% recorded patients taking some oral diet (with or without supplemental tube feedings) and 89% with functional tracheoesophageal voice in our series, laryngectomy achieves the goal of safe swallowing without aspiration and with reasonable voice rehabilitation. The relatively high rate of tracheoesophageal voice as compared with prior reports may be reflective of care at a high-volume tertiary care center.…”

Section: Discussionmentioning

confidence: 84%

“…A retrospective analysis of patients undergoing organ preservation approaches found that over half with tracheostomy prior to initiation of radiation remained tracheostomy dependent afterward. 18 Four other case series in the literature describe total laryngectomy for dysfunctional larynx, ranging from 19 to 32 patients, [6][7][8][9] to which we contribute an additional 23 patients. While the other series focused on reporting surgical outcomes, we sought to use a case-control design to identify factors associated with severe dysfunction warranting laryngectomy.…”

Section: Discussionmentioning

confidence: 99%

“…We report a pharyngocutaneous fistula rate of 27%, within the range of 13% to 44% reported in other series. [6][7][8][9] Three of the originally 26 scheduled laryngectomies were canceled due to severe medical comorbidities, highlighting the importance of patient selection in this medically complex population, as the 5-year overall survival rate has been reported to be as low as 35%. 7 Given the risks of surgery, it is crucial that patients receive preoperative counseling regarding realistic expectations for surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

Goldsmith

Holman

et al. 2020

Otolaryngol.--head neck surg.

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Objective (1) To identify factors associated with severe dysfunctional larynx leading to total laryngectomy after curative treatment of head and neck squamous cell carcinoma and (2) to describe swallowing and voice outcomes. Study Design Retrospective single-institution case-control study. Setting Tertiary care referral center. Methods A 10-year chart review was performed for patients who had previously undergone radiation or chemoradiation for head and neck mucosal squamous cell carcinoma and planned to undergo total laryngectomy for dysfunctional larynx, as well as a control group of matched patients. Controls were patients who had undergone radiation or chemoradiation for mucosal squamous cell carcinoma but did not have severe dysfunction warranting laryngectomy; these were matched to cases by tumor subsite, T stage, and time from last treatment to video swallow study. Main outcomes assessed were postoperative diet, alaryngeal voice, pharyngeal dilations, and complications. Results Twenty-six patients were scheduled for laryngectomy for dysfunctional larynx, of which 23 underwent surgery. Originally treated tumor subsites included the larynx, oropharynx, hypopharynx, oral cavity, and a tumor of unknown origin. The median time from end of cancer treatment to laryngectomy was 11.5 years. All cases were feeding tube or tracheostomy dependent or both prior to laryngectomy. As compared with matched controls, cases were significantly less likely to have undergone IMRT (intensity-modified radiotherapy) and more likely to have pulmonary comorbidities. Eighty-nine percent of cases with follow-up achieved functional alaryngeal voice, and all were able to have oral intake. Conclusion Non-IMRT approaches and pulmonary comorbidities are associated with laryngectomy for dysfunction after radiation or chemoradiation.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

Goldsmith

Holman

et al. 2020

Otolaryngol.--head neck surg.

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“…Surgical interventions have also been described for HNC patients with very severe and difficult-to-treat aspiration. In particular, patients with severe OD-related respiratory tract complications may benefit from surgical interventions such as vocal fold medialization techniques in case of vocal fold paralysis [373] (see "Management of oropharyngeal dysphagia as an adverse event and in case of palliation" section), a tracheotomy using cuffed tracheostomy tubes (see "Tracheostomy and oropharyngeal dysphagia in head and neck cancer" and "Complications due to oropharyngeal dysphagia in head and neck cancer" sections), laryngeal suspension surgery [370,375,374], and in selected cases laryngotracheal separation or a TLE [376][377][378][379]. These are, of course, interventions that are considered 'last resort surgical interventions' for the treatment of severe life-threatening OD.…”

Section: Surgical Treatment Of Oropharyngeal Dysphagia In Head and Nementioning

confidence: 99%

“…The number of studies on laryngeal suspension surgery and laryngotracheal separation in HNC patients is very limited and it mainly concerns smaller case series with a low level of evidence [370,[374][375][376]. The body of literature on functional laryngectomy for end-stage OD in HNC patients is slightly more extensive [377][378][379]. These surgical interventions do not guarantee an overall improvement of the swallowing function nor a normalization of oral intake without feeding tube dependency.…”

Section: Surgical Treatment Of Oropharyngeal Dysphagia In Head and Nementioning

confidence: 99%

European white paper: oropharyngeal dysphagia in head and neck cancer

Baijens

Walshe

Aaltonen

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

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Functional Laryngectomy and Quality of Life in Survivors of Head and Neck Cancer With Intractable Aspiration

Evangelista,

Nativ-Zeltzer,

Bewley

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceLate effects of head and neck cancer (HNC) treatment include profound dysphagia, chronic aspiration, and death. Functional laryngectomy (FL) can improve patient survival and quality of life (QoL); however, removing a failing larynx for a noncancer reason is a difficult decision. Data regarding the ability of FL to improve self-perceptions of voice, swallowing, and QOL in survivors of HNC with intractable aspiration are inconclusive.ObjectiveTo investigate the association of FL with changes in self-reported perceptions of voice, swallowing, oral intake, QoL, and mood in survivors of HNC experiencing profound dysphagia and intractable aspiration.Design, Settings, and ParticipantsThis cohort study was conducted at a single academic institution and included survivors of HNC with profound swallowing dysfunction and intractable aspiration who underwent FL from July 2016 through March 2022. Of the initial 22 patients enrolled, 2 patients (15%) died of aspiration pneumonia before receiving FL. Data analyses were performed from July 2016 through March 2023.Main Outcomes and MeasuresSelf-reported measures of voice using the VHI (30-item Voice Handicap Index), swallowing using the EAT-10 (10-item Eating Assessment Tool), functional oral intake scale using the FOIS (Functional Oral Intake Scale), and quality of life using the FACT-H&amp;N (Functional Assessment of Cancer Therapy−Head &amp; Neck) were assessed before FL and at 1, 3, and 6 months after FL. Mood states were evaluated using the POMS (Profile of Mood States, second edition), before FL and at 6 months after FL.ResultsThe study analyses included 20 patients (mean [SD] age, 72.4 (7.0) years; 19 [95%] males and 1 [5%] female) who underwent FL and had complete data across all time points. Among these, 12 patients (60%) had received chemoradiation for oropharyngeal, 7 (35%) for laryngeal, or 1 (5%) for nasopharyngeal cancer. The mean (SD) time from completion of oncologic treatment to FL was 15.5 (5.5) years. Mean (SD) score on the EAT-10 improved from 33.2 (7.4) to 23.1 (10.8) at 1 month; 12.1 (9.1) at 3 months; and 8.3 (7.4) at 6 months, with a large effect size (η2 = 0.72; 95% CI, 0.54-0.80). Mean (SD) score on the FOIS improved from 2.0 (1.5) to 2.9 (1.7) at 1 month; 4.8 (2.5) at 3 months; and 5.2 (1.7) at 6 months, with a large effect size (η2 = 0.6; 95% CI, 0.38-0.71). Improvement in oral intake was achieved in 19 patients (95%), and feeding tubes were removed in 10 of 16 patients (63%) who were feeding tube−dependent; 6 patients (27%) continued to require supplemental tube feedings. Mean (SD) score on the VHI improved from 63.6 (34.0) to 86.9 (33.7) at 1 month; 71.3 (36.1) at 3 months; and 39.7 (26.9) at 6 months, with a large effect size (η2 = 0.42; 95% CI, 0.19-0.56). Seventeen patients (85%) were able to use a tracheoesophageal voice prosthesis for alaryngeal communication. Mean (SD) score on the FACT-H&amp;N improved from 86.2 (17.8) to 93.6 (18.4) at 1 month; 109.0 (18.4) at 3 months; and 121.0 (16.8) at 6 months, with a large effect size (η2 = 0.64; 95% CI, 0.42-0.74). Mean (SD) score on the POMS improved from 58.9 (13.2) at baseline to 44.5 (9.9) at 6 months, with a large effect size (Cohen d = 1.04; 95% CI, 0.48-1.57). None of the patients experienced major complications of FL; 1 patient (5%) had a postoperative pharyngocutaneous fistula.Conclusions and RelevanceThe findings of this cohort study indicate that FL was associated with marked improvements in self-perception of voice and swallowing, functional oral intake, QoL, and mood state among survivors of HNC. These findings can serve as a framework for FL counseling among HNC survivors experiencing profound dysphagia and intractable aspiration.

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Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx

Cited by 13 publications

References 17 publications

Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

European white paper: oropharyngeal dysphagia in head and neck cancer

Functional Laryngectomy and Quality of Life in Survivors of Head and Neck Cancer With Intractable Aspiration

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