The impact of preoperative tracheotomy on T3 transglottic carcinomas of the larynx

Abstract

To evaluate the impact of the practice of a preoperative tracheotomy and different prognostic factors reported in the literature in patients with transglottic carcinoma of the larynx, a retrospective study was performed in the Instituto Nacional de Cancerologia, Mexico City. In all, 90 cases with T3 transglottic squamous cell carcinoma requiring a total laryngectomy as primary treatment were studied. Prognostic factors such as the Karnofsky index, tumor differentiation, surgical margins and preoperative tracheotomy were analyzed by a Cox's proportional hazards model. The Kaplan-Meier method and log rank test were used to evaluate the disease-free intervals and survival curves. Thirty-two patients had preoperative tracheotomies, while 58 did not. Eighty percent of the patients in the non-preoperative tracheotomy group were alive after 5 years versus 20% of those with preoperative tracheotomies (P < 0.001). Although possibly controversial, our findings indicate that a pretreatment tracheotomy should be avoided in T3 transglottic obstructive lesions. In patients with these lesions and a subglottic extension < or = 3 cm we recommend an emergency total laryngectomy when possible to increase survival and decrease surgical morbidity.

Concomitant Chemoradiation in Locally Advanced Laryngeal Cancer

“…Several studies have shown poor outcome of patients with tracheotomy. 18 The dismal survival of patients with tracheotomy in this series is consistent with literature and tracheotomy emerged as the only independent prognostic factor significantly associated with poor LFS on multivariate analysis. The potential risk of prolongation of radiotherapy treatment time in head and neck is well documented.…”

Impact of Previous Tracheotomy as a Prognostic Factor in Patients with Locally Advanced Squamous Cell Carcinoma of the Larynx Submitted to Concomitant Chemotherapy and Radiation

“…CR to chemoradiation has already been reported as an important prognostic factor for overall survival in previous studies including different chemoradiation protocols [14] . Carrilo et al [15] retrospectively studied the negative impact of preoperative tracheotomy in T3 transglottic tumors submitted to total laryngectomy. Ninety cases were studied, and 32 needed a preoperative tracheotomy.…”

“…Based on this information, some authors recommend an immediate total laryngectomy instead of an emergency tracheotomy [15][16][17] . During follow-up, only 2 patients with tracheotomy had stomal relapses; most relapses were loco-regional, independent of tracheotomy status.…”

“…Cycles could be delayed up to 2 weeks or the dose could be reduced according to toxicity (NCI toxicity criteria grade 3 or 4) [15] . Treatment with cisplatin was discontinued in patients with grade 3 hearing loss or a creatinine clearance of !…”

Induction Chemotherapy in Locally Advanced Pharyngolaryngeal Cancers with Stridor: Is It Feasible and Safe?

“…The local control rate is poorer even when the patients undergo laryngectomy. Tracheostomy has been associated with inferior duration of OS and increased rate of distant metastasis in some series [4–6]. …”