Clinicopathologic Findings and Treatment Outcome of Laryngectomized Patients with Laryngeal Cancer and Hypopharyngeal Cancer: An Experience in Thailand

Incidence and complications of hypothyroidism postlaryngectomy: A systematic review and meta-analysis

BACKGROUND

Hypothyroidism is common postlaryngectomy and is associated with laryngectomy-specific complications. The objective of this study is to determine the incidence and predictors of hypothyroidism postlaryngectomy and its associated complications.

METHODS

Systematic review, data extraction, and meta-analyses were performed following the PRISMA protocol. Six databases were searched for studies reporting on postlaryngectomy thyroid status with incidence, risk factors, management, or complications.

RESULTS

Fifty-one studies with 6333 patients were included. The pooled incidence of postlaryngectomy hypothyroidism is 49% (CI 42%-57%). Subgroup analysis showed postlaryngectomy hypothyroidism rates significantly correlated with hemithyroidectomy and radiotherapy. Patients who underwent laryngectomy, hemithyroidectomy, and radiotherapy had a 65% (CI 59%-71%) rate of hypothyroidism; laryngectomy and hemithyroidectomy 46% (CI 33%-60%); laryngectomy and radiotherapy 26% (CI 19%-35%); and laryngectomy alone 11% (CI 4%-27%) (p < 0.001).

CONCLUSIONS

Laryngectomized patients with partial thyroidectomy or radiation therapy are at significant risk of postoperative hypothyroidism. Evidence-based protocols for early detection and (prophylactic) treatment should be established.

Surgically-Treated Locoregionally Advanced Hypopharyngeal Cancer: Outcomes

Introduction  Hypopharyngeal tumors are head and neck malignancies associated with a great mortality rate, and the treatment of advanced lesions constitutes a challenging problem. Pharyngolaryngectomy continues to be the gold standard treatment modality for locally-advanced diseases, and it is currently used as the primary treatment or in cases of relapse after an organ preservation strategy.

Objective  This study aims to compare the survival rates of patients with advanced hypopharyngeal tumors treated with pharyngolaryngectomy as a primary or salvage option, and identify possible prognostic factors.

Methods  All patients with advanced hypopharyngeal squamous cell carcinomas who performed pharyngolaryngectomy between 2007 and 2014 were reviewed retrospectively.

Results  A total of 87 patients fulfilled the aforementioned criteria, and the sample had a mean age of 57.2 years and a male predominance of 43:1. The tumors were located in the pyriform sinus walls (81 tumors), in the posterior pharyngeal wall (4 tumors) and in the postcricoid region (2 tumors). A total of 60 patients underwent surgery as the primary treatment option, and 27 were submitted to salvage pharyngolaryngectomy after a previous treatment with chemoradiotherapy or radiotherapy. The 5-year overall survival was of 25.9%, the 5-year disease-free survival was of 24.2%, and the disease-specific survival was of 29.5%.

Conclusion  The patients treated with pharyngolaryngectomy as the primary option revealed a better 5-year-disease free survival than the patients who underwent the salvage surgery (35.8% versus 11.7% respectively; p  < 0.05). The histopathological criteria of capsular rupture of the lymph nodes (30.1% versus 19.8% respectively for the primary and salvage groups; p  < 0.05) and vascular invasion (30.5% versus 22.5% respectively; p  < 0.05) reduced the 5-year disease-free survival. Pharyngolaryngectomy as the primary intent revealed a lower local recurrence rate than the salvage surgery (40.6% versus 83.3% respectively; p  < 0.05).