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Kinkhabwala CM, Amin J, Rist T, Vaitaitis VJ, Skoner JM. Latissimus dorsi myocutaneous free flap for the laryngopharyngectomy defect. Head Neck 2024; 46:2048-2055. [PMID: 38391089 DOI: 10.1002/hed.27682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Partial or total laryngopharyngectomy defects have traditionally been reconstructed using the radial forearm, anterolateral thigh, or jejunal free flaps. The latissimus dorsi myocutaneous free flap (LDMFF) is an option for high-risk patients with complex laryngopharyngeal ± cutaneous neck defects. METHODS Retrospective single-surgeon case series from 2017 to 2022. Outcomes were assessed at both the back donor site and head and neck. RESULTS Twenty-four patients were identified. Flap survival was 100%. There was 1 (4.2%) pharyngocutaneous fistula and 2 (8.3%) tracheo-esophageal peristomal fistulas. At last follow-up, 17 (71%) were sustaining weight on oral intake, and 7 (29%) were G-tube dependent with 4 of these able to do some type of oral intake. Seven (29.2%) had post-operative stricture/stenosis requiring dilation. There were only minor donor site complications, all managed conservatively. CONCLUSIONS The LDMFF can be a robust reconstructive option, particularly for radiated high-risk patients with complex pharyngeal defects, including skin.
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Affiliation(s)
- Corin M Kinkhabwala
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julian Amin
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tyler Rist
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vilija J Vaitaitis
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Judith M Skoner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Williamson A, Shah F, Benaran I, Paleri V. Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta-analysis. Laryngoscope 2024; 134:2991-3002. [PMID: 38238878 DOI: 10.1002/lary.31287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.2% after primary and flap-assisted closure respectively. We aim to better define the role of vascularized flaps after salvage laryngectomy by performing an updated review comparing the rate of PCF in those undergoing primary or vascularized flap-assisted closure. DATA SOURCES Pubmed/Medline, CINAHL, and CENTRAL. REVIEW METHODS An updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta-analysis of odds ratios (OR) and pooled proportions were conducted. RESULTS Literature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I2 = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I2 = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I2 = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I2 = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on-lay and patch closure compared to primary closure techniques. Network meta-analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure. CONCLUSION The updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap-assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 134:2991-3002, 2024.
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Affiliation(s)
- Andrew Williamson
- Department of Head and Neck Surgery, The Royal Marsden Hospital, International Centre for Recurrent Head and Neck Cancer (IReC), London, United Kingdom
- Institute for Cancer Research, London, United Kingdom
| | - Faizan Shah
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Irene Benaran
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Glasgow, United Kingdom
| | - Vinidh Paleri
- Department of Head and Neck Surgery, The Royal Marsden Hospital, International Centre for Recurrent Head and Neck Cancer (IReC), London, United Kingdom
- Institute for Cancer Research, London, United Kingdom
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Kanyo EC, Wu SS, Reddy CA, Silver NL, Lamarre ED, Burkey BB, Prendes BL, Scharpf J, Lorenz RR, Kmiecik J, Ku JA. Primary fit tracheoesophageal puncture in primary versus salvage laryngectomy: Short-term and long-term complications and functional outcomes. Head Neck 2024. [PMID: 38655707 DOI: 10.1002/hed.27788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 02/09/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Primary fit tracheoesophageal puncture (TEP) is widely preferred for individuals who have not undergone prior radiation. However, there is no consensus on the relative utility of primary-fit TEP in the setting of salvage laryngectomy. METHODS A retrospective, single-center review was conducted of individuals undergoing laryngectomy with primary fit TEP between 2012 and 2018. Multivariable analysis was conducted to compare short-term and long-term complications, as well as speech and swallowing outcomes, of those who underwent primary versus salvage laryngectomy. RESULTS In this study, 134 patients underwent total laryngectomy with primary fit TEP. Aside from a higher rate of peristomal dehiscence (13.1% vs. 1.4%) found in the salvage group, there was no difference in incidence of all other complications, including pharyngocutaneous fistula formation. The groups had comparable speech and swallow outcomes. CONCLUSION Primary fit TEP is a safe and effective surgical choice for individuals undergoing salvage laryngectomy who desire a voice prosthesis.
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Affiliation(s)
- Emese C Kanyo
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shannon S Wu
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joann Kmiecik
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie A Ku
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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4
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El Shatanofy M, Youner E, Shaver TB, Chaudhry T, Goodman J. A NSQIP study comparing surgical outcomes between primary and non-primary TEPs after total laryngectomy. Am J Otolaryngol 2024; 45:104026. [PMID: 37634302 DOI: 10.1016/j.amjoto.2023.104026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Tracheoesophageal puncture with voice prosthesis (TEP) is considered the gold standard for voice rehabilitation after total laryngectomy; however, there is debate as to whether it should be inserted concurrently with removal of the larynx (primary TEP), or as a separate, additional procedure at a later date (secondary TEP). We utilized the National Surgical Quality Improvement Program Database (NSQIP) to compare postoperative complications, readmission rates, and reoperation rates among individuals who underwent total laryngectomy with or without concurrent TEP placement. METHODS We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) from 2012 to 2019. Patients were categorized into primary and non-primary TEP groups using a variation of CPT codes for total laryngectomy, tracheoesophageal prosthesis, and type of reconstruction. Univariate analyses were performed and significance was determined at p < 0.05. RESULTS A total of 1974 patients who underwent total laryngectomy were identified from the database: 1505 (77.3 %) in the non-primary TEP group and 442 (22.7 %) in the primary TEP group. Patients in the non-primary TEP group were more likely to have an ASA class greater than or equal to three (91.2 % primary vs. 84.6 % non-primary, p < 0.001). Patients in the non-primary TEP group were also more likely to require intraoperative or postoperative blood transfusions within the first 72 h of surgery (20.5 % non-primary vs. 15.3 % primary, p = 0.016). Both groups had similar rates of wound breakdown and dehiscence. There remained no significant difference based on type of reconstruction. CONCLUSIONS This study suggests that patients receiving primary TEPs are not at a greater risk of developing wound complications such as pharyngocutaneous fistulas in the 30-day postoperative period. This remained true when patients were stratified by type of flap reconstruction. Patients in the non-primary TEP group were more likely to have an ASA category of 3 or greater, which may explain why they experienced higher rates of complications such as blood transfusions intra-operatively or post-operatively.
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Affiliation(s)
- Muhammad El Shatanofy
- Department of Otolaryngology, George Washington University Hospital, Washington, DC 20037, USA; Department of Otolaryngology, University of Miami Hospital, Miami, FL 33136, USA.
| | - Emily Youner
- Department of Otolaryngology, George Washington University Hospital, Washington, DC 20037, USA; Department of Otolaryngology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Timothy B Shaver
- Department of Otolaryngology, George Washington University Hospital, Washington, DC 20037, USA
| | - Taimur Chaudhry
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; Albany Medical College, Albany, NY 12208, USA
| | - Joseph Goodman
- Department of Otolaryngology, George Washington University Hospital, Washington, DC 20037, USA
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Haga Y, Yasunaga Y, Araki J, Nakao J, Mori H, Nakagawa M, Mukaigawa T. Perioperative Factors Aggravating Pharyngocutaneous Fistula After Total Laryngectomy: A Single-Center Retrospective Analysis Using the Clavien-Dindo Classification. Ann Plast Surg 2023; 91:84-89. [PMID: 37450865 DOI: 10.1097/sap.0000000000003627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Pharyngocutaneous fistula formation represents a major postoperative complication following total laryngectomy. We aimed to investigate the risk factors for pharyngocutaneous fistula development after total laryngectomy and to identify factors that lead to severe cases of pharyngocutaneous fistula. METHODS Patients who underwent total laryngectomy between January 2013 and February 2021 were included in the study and were divided into 2 groups: Those with and without pharyngocutaneous fistula. The severity of pharyngocutaneous fistula was graded using the Clavien-Dindo classification. RESULTS Patients with pharyngocutaneous fistula experienced longer operative time, greater intraoperative blood loss, greater decrease in perioperative hemoglobin level, and longer postoperative hospitalization. Unlike in lower-severity cases, patients with grade IIIb pharyngocutaneous fistula underwent preoperative radiotherapy or chemoradiotherapy; preoperative treatment was thus a risk factor for higher severity of pharyngocutaneous fistula (odds ratio, 35; P = 0.004). CONCLUSION Salvage laryngectomy was found to be a predictor of severe pharyngocutaneous fistula development. Prolonged operative time, increased intraoperative blood loss, and decreased postoperative hemoglobin level were found to be predictors of postlaryngectomy pharyngocutaneous fistula formation.
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Affiliation(s)
| | - Yoshichika Yasunaga
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Jun Araki
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Junichi Nakao
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Hiroaki Mori
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | | | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
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Šifrer R, Strojan P, Tancer I, Dolenc M, Fugina S, Zore SB, Aničin A. The Incidence and the Risk Factors for Pharyngocutaneous Fistula following Primary and Salvage Total Laryngectomy. Cancers (Basel) 2023; 15:cancers15082246. [PMID: 37190174 DOI: 10.3390/cancers15082246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/26/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
The pharyngocutaneous fistula (PCF) is the most common complication following a total laryngectomy (TL) with a wide range of incidence and various potential risk factors. The aim was to analyse the incidence and potential risk factors for PCF formation in a large study set collected over a longer period of time. In the retrospective study at the Department of Otorhinolaryngology and Cervicofacial Surgery of Ljubljana, 422 patients who were treated for head and neck cancer by TL between 2007 and 2020 were included. The comprehensive clinicopathologic data were collected including potential risk factors related to the patient, disease, surgical treatment and post-operative period for the development of fistulae. The patients were categorized into a group with the fistula (a study group) and one without it (a control group). The PCF then developed in 23.9% of patients. The incidence following a primary TL was 20.8% and 32.7% following salvage TL (p = 0.012). The results demonstrated that surgical wound infection, piriform sinus invasion, salvage TL, and total radiation dose were determined as independent risk factors for PCF formation. A diminishing surgical wound infection rate would contribute to a further reduction of the PCF rate.
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Affiliation(s)
- Robert Šifrer
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Primož Strojan
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Department of Radiation Oncology, Institute of Oncology, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Ivana Tancer
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Maja Dolenc
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Simon Fugina
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Sara Bitenc Zore
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Aleksandar Aničin
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Okafor S, Awaonusi OO, Watts TL, Cannon TY. Salvage Surgery. Otolaryngol Clin North Am 2023; 56:323-331. [PMID: 37030945 DOI: 10.1016/j.otc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
The Department of Veterans Affairs Laryngeal Cancer Study propelled the combination of chemotherapy and radiation therapy to the forefront of strategies used for the management of locally advanced laryngeal cancer. The organ preservation rate was 84%. However, over the past 30 years that these approaches have been in place, there have been concerns regarding long-term survival and high failure rates requiring salvage. Furthermore, salvage laryngectomy, if feasible when considering increased morbidity after CRT, is fraught with a higher risk of wound complications including fistula, longer hospitalization, and reduced quality of life.
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Affiliation(s)
- Somtochi Okafor
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, USA
| | - Oluwaseyi O Awaonusi
- Indian University, School of Medicine, 340 West 10th Street, Indianapolis, IN 46202, USA
| | - Tammara L Watts
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, USA
| | - Trinitia Y Cannon
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, 2301 Erwin Road, Durham, NC 27710, USA; Department of Head and Neck Surgery & Communication Sciences, Duke Raleigh Hospital, 3404 Wake Forest Road Suite 202, Raleigh, NC 27609, USA.
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Abstract
Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this procedure. The surgical techniques employed in total laryngectomy have not been comprehensively discussed to date. Thus, the main objective of this article was to address controversial aspects related to this procedure and compare different surgical techniques used for a total laryngectomy procedure from the beginning to the end. Although the management paradigms in laryngeal and hypopharyngeal squamous cell carcinomas have shifted to organ-preserving chemoradiotherapy protocols, total laryngectomy still plays a prominent role in the treatment of advanced and recurrent tumors. The increased incidence of complications associated with salvage total laryngectomy has driven efforts to improve the surgical techniques in various aspects of the operation. Loss of voice and impaired swallowing are the most difficult challenges to be overcome in laryngectomies, and the introduction of tracheoesophageal voice prostheses has made an enormous difference in postoperative rehabilitation and quality of life. Advancements in reconstruction techniques, tumor control, and metastatic management, such as prophylactic neck treatments and paratracheal nodal dissection (PTND), as well as the use of thyroid gland-preserving total laryngectomy in selected patients have all led to the increasing success of modern total laryngectomy. Several conclusions regarding the benchmarking of surgical techniques cannot be drawn. Issues regarding total laryngectomy are still open for discussion, and the technique will continue to require improvement in the near future.
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Affiliation(s)
- Adit Chotipanich
- Otolaryngology Department, Chonburi Cancer Hospital, Ministry of Public Health, Chonburi, THA
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Cabrera CI, Joseph Jones A, Philleo Parker N, Emily Lynn Blevins A, Weidenbecher MS. Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:972-983. [PMID: 32988281 DOI: 10.1177/0194599820957962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). DATA SOURCES Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. REVIEW METHODS A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. RESULTS Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. CONCLUSIONS This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.
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Affiliation(s)
- Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Alexander Joseph Jones
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Noah Philleo Parker
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Amy Emily Lynn Blevins
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Mark S Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
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10
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Bertolin A, Lionello M, Zanotti C, Franz L, Giacomelli L, Rizzotto G, Marioni G. Oncological and Functional Outcomes of Primary and Salvage Total Laryngectomy. Laryngoscope 2020; 131:E569-E575. [PMID: 32770763 DOI: 10.1002/lary.28955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate and compare the oncological and functional outcomes of total laryngectomies (TL) performed as first line treatment or for salvage after failure of conservative approaches for treating advanced laryngeal carcinoma (LSCC). STUDY DESIGN A retrospective cohort study. METHODS A cohort of 217 patients who underwent TL was divided according to whether the procedure was for primary treatment of their LSCC (101 patients) or for recurrences after conservative surgery or chemo-radiotherapy (116 patients). RESULTS The overall survival rate and disease-specific survival rate were significantly higher in the primary TL group than in the salvage TL group (P = .04 and P = .01, respectively). The recurrence rate was significantly higher and the disease-free survival (in months) was shorter for patients who had salvage TL than for those who had primary TL (P = .00 and P = .01, respectively). The salvage TL group also included significantly more cases of postoperative pharyngo-cutaneous fistula needing salivary stent positioning, and experienced significantly longer hospital stays than the primary TL group (P = .04 and P = .03, respectively). CONCLUSION Oncological and functional outcomes of primary TL were significantly better than after salvage TL. If salvage TL was performed after conservative surgery had failed, the oncological and functional results were better than after the failure of organ-preserving protocols. This could justify a first attempt at conservative surgery for intermediate-advanced LSCC in selected cases, reserving chemo-radiotherapy only for patients unsuitable for surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E569-E575, 2021.
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Affiliation(s)
- Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - Marco Lionello
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - Claudia Zanotti
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Luciano Giacomelli
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | | | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy
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11
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Brook I. "The Laryngectomee Guide" is available now in Portuguese. Braz J Otorhinolaryngol 2019; 85:809. [PMID: 31383593 PMCID: PMC9443002 DOI: 10.1016/j.bjorl.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Itzhak Brook
- Georgetown University Medical Center, Washington, USA.
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12
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Marchi F, Filauro M, Missale F, Parrinello G, Incandela F, Bacigalupo A, Vecchio S, Piazza C, Peretti G. A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases. Cancers (Basel) 2019; 11:E717. [PMID: 31137671 PMCID: PMC6562846 DOI: 10.3390/cancers11050717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022] Open
Abstract
The optimal treatment for T3 laryngeal carcinoma (LC) is still a matter of debate. Different therapeutic options are available: Transoral laser microsurgery (TLM), open partial horizontal laryngectomies (OPHLs), total laryngectomy (TL), and organ preservation protocols (radiation therapy (RT) or chemo-radiation (CRT)). This study aimed to retrospectively evaluate oncologic outcomes of 104 T3 LCs treated by surgery or non-surgical approaches from January 2011 to December 2016 at a single academic tertiary referral center. Each case was evaluated by a multidisciplinary team (MDT) devoted to the management of head and neck cancers. We divided the cohort into two subgroups: Group A, surgical treatment (TLM, OPHLs, TL) and Group B, non-surgical treatment (RT, CRT). For the entire cohort, two- and five-year overall survival (OS) rates were 83% and 56%, respectively. The two- and five-year disease-free survival (DFS) rates were 75% and 65%, and disease-specific survival rates were 93% and 70%, respectively. The N category was a significant independent prognosticator for OS (p = 0.02), whereas Group B was significantly and independently associated with DFS (HR 4.10, p = 0.006). Analyzing laryngo-esophageal dysfunction-free survival as an outcome, it was found that this was significantly lower in higher N categories (p = 0.04) and in cases that underwent non-surgical treatments (p = 0.002). Optimization of oncologic outcomes in T3 LCs may be obtained only by a comprehensive MDT approach, considering that different treatment options have heterogenous toxicity profiles and indications.
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Affiliation(s)
- Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Giampiero Parrinello
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
| | - Fabiola Incandela
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Almalina Bacigalupo
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Radiation Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Stefania Vecchio
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Oncology, University of Genoa, 16132 Genoa, Italy.
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy.
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, 16132 Genoa, Italy.
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