Outcomes of Elective Total Laryngectomy for Laryngopharyngeal Dysfunction in Disease-free Head and Neck Cancer Survivors

Overview

Journal Otolaryngol Head Neck Surg

Publisher Wiley

Specialties General Surgery
Otorhinolaryngology

Date 2012 Jan 12

PMID 22235071

Citations 13

Authors

Katherine A Hutcheson

Clare P Alvarez

Denise A Barringer

Michael E Kupferman

Peter R Lapine

Jan S Lewin

Affiliations

Soon will be listed here.

Abstract

Objective: Total laryngectomy (TL) can be offered for management of chronic aspiration, radionecrosis, and/or airway compromise after head and neck cancer (HNC) treatment. The objective of this study was to evaluate functional outcomes after TL in disease-free HNC survivors.

Design: Retrospective case series with chart review.

Setting: The University of Texas MD Anderson Cancer Center.

Patients: Twenty-three disease-free HNC survivors who underwent TL for laryngopharyngeal dysfunction.

Intervention: TL ± pharyngectomy.

Main Outcome Measures: Post-TL swallowing-related (diet, gastrostomy dependence, and pneumonia rates) and communication outcomes.

Results: All patients who underwent TL for dysfunction were previously treated with radiotherapy (12/23, 52%) or chemoradiotherapy (11/23, 48%). Preoperative complications included aspiration (22/23, 96%), pneumonia (16/23, 70%), tracheostomy (9/23, 39%), and stricture (7/23, 30%); 17 patients (74%) required enteral/parenteral nutrition, and 13 of 23 (57%) were nothing per oral (NPO). Rates of pneumonia, NPO status, and feeding tube dependence significantly decreased after TL (P < .001). At last follow-up after TL, all patients tolerated oral intake, but 4 (17%) required supplemental enteral nutrition. Continued smoking after radiotherapy and a preoperative history of recurrent pneumonia were significantly (P < .05) associated with final tube dependence and/or diet level. Sixteen patients (70%) underwent tracheoesophageal (TE) puncture, and 57% (13 of 23) communicated using TE voice after TL.

Conclusion: Salvage TL may improve health status by significantly decreasing the rate of pneumonia and improve quality of life by restoring oral intake in patients with refractory laryngopharyngeal dysfunction after HNC treatment. TE voice restoration may enhance functional outcomes in select patients treated with elective TL for dysfunction.

Citing Articles

Wong E, Smith M, Buchanan M, Kudpaje A, Williamson A, Hedge P Eur Arch Otorhinolaryngol. 2023; 280(8):3861-3866.

PMID: 37115324 PMC: 10313529. DOI: 10.1007/s00405-023-07976-0.

Prognostic Significance of Vocal Cord Mobility after Laryngeal Preservation Protocols in Locally Advanced Laryngopharyngeal Cancers: A Retrospective Analysis.

U S Rao V, Majumdar K, Subash A, Banerjee N, Sinha P, Prasad R Indian J Otolaryngol Head Neck Surg. 2021; 73(2):207-211.

PMID: 34150595 PMC: 8163924. DOI: 10.1007/s12070-020-02306-w.

European white paper: oropharyngeal dysphagia in head and neck cancer.

Baijens L, Walshe M, Aaltonen L, Arens C, Cordier R, Cras P Eur Arch Otorhinolaryngol. 2020; 278(2):577-616.

PMID: 33341909 PMC: 7826315. DOI: 10.1007/s00405-020-06507-5.

Reconstructive Options During Nonfunctional Laryngectomy.

Escalante D, Vincent A, Wang W, Shokri T, Ducic Y Laryngoscope. 2020; 131(5):E1510-E1513.

PMID: 33037821 PMC: 8247398. DOI: 10.1002/lary.29154.

Speech and swallowing outcomes after laryngectomy for the dysfunctional irradiated larynx.

Farlow J, Birkeland A, Hardenbergh A, Lyden T, Brenner J, Shuman A Eur Arch Otorhinolaryngol. 2020; 277(5):1459-1465.

PMID: 31989269 DOI: 10.1007/s00405-020-05809-y.

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