Surgical complications of salvage total laryngectomy following concurrent chemoradiotherapy

Furuta, Yasushi; Homma, Akihiro; Oridate, Nobuhiko; Suzuki, Fumiyuki; Hatakeyama, Hyōe; Suzuki, Kazushige; Nishioka, Takeshi; Shirato, Hiroki; Fukuda, Satoshi

doi:10.1007/s10147-008-0787-x

Cited by 82 publications

(76 citation statements)

References 18 publications

(27 reference statements)

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“…In other studies [18,[25][26][27][28] mean time of restoration a normal feeding was 25 days and in Pellini's study was in less than 1 month for 61.5 % of patients [22]. The time of removal of the feeding tube ranged in literature from 10-96 days [28] to 12-90 days [18], in our study was 4-230 days.…”

Section: Complications and Functional Resultssupporting

confidence: 39%

Surgical options in radiotherapy-failed early glottic cancer

Santoro

Meccariello

Mannelli

et al. 2013

Eur Arch Otorhinolaryngol

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After failure of curative radiotherapy (RT), surgery is the main therapeutic option to control recurrent laryngeal cancer. Recurrences after RT for T1-T2 tumours of the glottic larynx are often diagnosed at a more severe stage than the original disease and, thus, usually treated by radical approaches. Our aim is to investigate the feasibility of more conservative strategies for proper treatment of post-RT recurred glottic cancer. We collected and reviewed our files from 1990 to 2006, selecting 75 patients which matched the following inclusion criteria: (1) patient was originally diagnosed with early stage squamous cell carcinoma of the glottic larynx (stage I-II according to 2010 TNM), (2) patient was treated by RT with curative intent, (3) patient presented a recurrence of disease after RT which was surgically treated at our Institution. T stage at first diagnosis was T1a in 41 cases (55 %), T1b in 12 (16 %) and T2 in 22 (29 %). At clinical examination of RT-recurred lesions, we documented advanced lesions (rT3-rT4) in 29 out of 75 patients (39 %). Overall, an upstage was reported for 56 % RT-recurred cancers, while 37.3 % remained at the same stage than the original tumour and 6.7 % were downstaged. Twelve patients (16 %) underwent salvage partial laryngectomy (SPL), while 63 (84 %) received a salvage total laryngectomy (STL). Multivariate analysis showed that rTNM according to the AJCC-UICC of 2010 was the only prognostic factor for both disease-free survival (p = 0.042) and overall survival (p = 0.004). Considering the prognostic impact of rT and rN we documented a statistical significance only in terms of overall survival for both factors (p = 0.004 and p = 0.04, respectively). Although STL remains the most frequent treatment choice for failures after RT in laryngeal carcinomas, SPL represents a valid option for selected patients with limited recurrence and can deliver good oncologic and functional results if performed according to careful indications.

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Section: Complications and Functional Resultssupporting

confidence: 39%

Surgical options in radiotherapy-failed early glottic cancer

Santoro

Meccariello

Mannelli

et al. 2013

Eur Arch Otorhinolaryngol

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“…Prior radiotherapy influences wound healing and increases the risk of developing wound complications; the role of concomitant chemotherapy, however, is not known. Furuta et al [14] compared the surgical complication rates of total laryngectomy with preoperative treatment. They noted an increase in the frequency and severity of wound complications in patients who underwent salvage total laryngectomy after CCRT, but this was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

Esteller

Vega

López

et al. 2010

Eur Arch Otorhinolaryngol

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With the increasing use of concomitant chemoradiotherapy (CCRT) in the treatment of advanced head and neck carcinoma, surgery has lost ground as the first therapy and is reserved as a salvage treatment in cases of locoregional failure. The objective of our study was to review our experience in patients who had a local or regional recurrence after treatment with CCRT. Thirty-two patients underwent salvage surgery after CCRT: 24 were treated with a local or locoregional resection and 8 patients with a neck dissection only. In patients who had surgery involving the primary location of the tumor, some kind of reconstruction was required in 83% of cases. One or more postoperative complications occurred in nine patients. The median hospital stay was 18.5 days. There was a significant difference in hospital stay in relation to the appearance of surgical complications. Five-year adjusted survival after salvage surgery was 34.2% (CI 95% 13.2-55.2%). Adjusted survival was related to the status of the resection margins and appearance of neck nodes with extracapsular spread in the neck dissection. In conclusion, salvage surgery after CCRT involves extensive resections, requiring reconstruction techniques with regional or microanastomosed free flaps in most cases, achieving acceptable outcomes.

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“…While some authors have found that the complication rate for salvage surgery after chemoradiotherapy is higher than that after radiotherapy alone [7][8][9], others report no significant differences [10][11][12].…”

Section: Introductionmentioning

confidence: 92%