Total laryngectomy for laryngeal cancer in a nigerian tertiary health center: prognosis and outcome

Clinical profile and treatment outcome of laryngeal cancer in a Nigerian Tertiary hospital

Background

Laryngeal cancer is one of the most common malignancies of the upper aerodigestive tract worldwide, and its management may sometimes be challenging, especially in developing countries due to late presentation, poverty and limited resources.

Aim

This study aims to highlight the clinical profile and treatment outcome of laryngeal cancer in our centre.

Patients and Methods

This was a retrospective review of patients who were managed for laryngeal cancer between January 2011 and December 2020.

Results

There were 90 (89.1%) males and 11 (10.9%) females, with a male-to-female ratio of 8.2:1. The age ranged from 22 to 82 years, with a mean age of 57.2 ± 12.7 years. Fifty patients (49.5%) presented more than 1 year after the onset of the symptoms. Squamous cell carcinoma (SCCA) was the only histological diagnosis observed in our patients. The laryngeal cancer was transglottic in location in 45 (44.6%) patients, while 50 (49.5%) patients presented with Stage III disease. Twenty-one (20.8%) patients had total laryngectomy. Amongst the patients managed, 17 (17.0%) were still on follow-up. Up to 37 (37.0%) were referred for radiotherapy elsewhere after chemotherapy. Forty-one of the patients (40.0%) died during the course of their management. There was a statistically significant association between having definitive surgical management and survival beyond 5 years (Chi-square test = 8.635, P = 0.003).

Conclusion

Majority of the patients presented late with transglottic SCCA. Surgical extirpation of the lesion was associated with better prognosis in our patients.

Total laryngectomy - past, present, future

In a period in which therapeutic approaches for malignant laryngeal tumors are focused on the principle of "organ preservation", total laryngectomy is a well coded surgical procedure, addressed to the advanced laryngeal cancer which is not suitable for conservative techniques or in case of their failure. The main objective of this work is to summarize the important events that have marked the evolution of this surgical technique to the current formula. Also this paper aims to identify, in our own casuistry, some elements of strategy and surgical technique required, in our opinion, for a successful therapeutic intervention. The fundamental significance of the study is that we must learn from the past, perform our surgeries at contemporary standards and look to the future for new solutions and approaches of the advanced laryngeal malignancies.