Stomal recurrence after primary total laryngectomy

Abstract

Stomal recurrence after total laryngectomy is usually considered to be incurable. A total of 402 patients suffering from squamous cell carcinoma of the larynx treated by total laryngectomy during the period 1982-96 were analysed. In the group of patients studied, the significant risk factors for stomal recurrence were glottic-subglottic tumour localization and regional tumour spread. Postoperative radiotherapy can significantly reduce the risk of stomal recurrence.

Prognostic Importance of Paratracheal Lymph Node Metastases

“…Prognostication for patients treated with a TL is important. A number of patient, tumor, and treatment related factors have been linked to prognosis after TL 1,9–12 . In our series, the following widely accepted prognostic factors were found to reach statistical significance: presence, number and ENS of lymph node metastases in the neck (level I–V), and subglottic extension.…”

“…Surprisingly, none of the hypopharyngeal (excluding postcricoid) tumors had PTLN metastases 7 . Other studies report a lower incidence of 9% in laryngeal carcinomas 8,9 . Because in none of these studies selection criteria for PTLN dissection were well defined, these results are difficult to compare.…”

“…Shenoy et al 8 found that in 9% of patients with T3 or T4 glottic tumors and tumor‐positive necks there were ipsilateral PTLN metastases and in 4.5%, contralateral PTLN metastases. Petrovic and Djordjevic 9 performed PTLN dissections in all T3 and T4 glottic and subglottic laryngeal carcinomas and found an incidence of PTLN metastases of 9%. Because the reported incidence of PTLN metastases is low in supraglottic and glottic carcinomas without subglottic extension, some authors do not recommend routine paratracheal dissections for these tumors.…”

Oncologic outcomes of total laryngectomy: Impact of margins and preoperative tracheostomy

“…Outcomes after total laryngectomy are strongly correlated with disease stage. In particular, nodal status is well established to be a very significant prognosticator . Other important prognostic factors include advanced T classification, poor differentiation, and margin status…”

Pre-operative tracheostomy does not impact on stomal recurrence and overall survival in patients undergoing primary laryngectomy

“…Since that time several papers have shown a poor outcome with POT [3,5,20] and others have found no relation [21][22][23][24][25][26].…”