Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: A national analysis

BACKGROUND

Surgical treatment of cancers that arise from or invade the hypopharynx presents major reconstructive challenges. Reconstructive failure exposes the airway and neck vessels to digestive contents.

METHODS

We performed a national N = near-all analysis of the administrative dataset to identify pharyngolaryngectomies in England between 2002 and 2012. Information about morbidity, pharyngeal closure method and post-operative complications was derived.

RESULTS

There were 1589 predominantly male (78%) patients whose mean age at surgery was 62 years. The commonest morbidities were hypertension (24%) and ischemic heart disease (11%). For 232 (15%) patients, pharyngolaryngectomy was performed during an emergency admission. The pharynx was closed primarily in 551 patients, with skin or muscle free or pedicled flaps in 755 patients and with jejunum and gastric pull-up in 123 and 160 patients, respectively. In-hospital mortality rate was 6% and was significantly higher in the gastric pull-up group (11%). Reconstructive failure had an odds ratio of 6.2 [95% confidence interval (CI) 2.4-16.1] for in-hospital death. The five-year survival was 57% and age, morbidities, emergency surgery, gastric pull-up, major acute cardiovascular events, renal failure and reconstructive failure independently worsened prognosis. Patients who underwent pharyngeal reconstruction with radial forearm or anterolateral thigh flaps had lower mortality rates than patients who had jejunum flap reconstruction (hazard ratio = 1.50 [95% CI 1.03-2.19]) or gastric pull-up (hazard ratio = 1.92 [95% CI 1.32-2.80]).

CONCLUSIONS

Pharyngolaryngectomy carries a high degree of risk of morbidity and mortality. Reconstructive failure worsens short- and long-term prognosis, and the use of cutaneous free flaps appears to improve survival.

The influence of age on postoperative complications after total laryngectomy or pharyngolaryngectomy

OBJECTIVE

This study aimed to evaluate the role of age in the occurrence of postoperative complications after total laryngopharyngectomy (TLP) or total laryngectomy (TL).

MATERIALS AND METHODS

This was a retrospective study including all patients who underwent TLP or TL in our institution between January 2005 and December 2010. The impact of age (greater than 65 years), history of cancer treatments and comorbidities on early postoperative course was analyzed using univariate and multivariate analyses.

RESULTS

Out of the 97 patients operated on, 21% had cancer of the hypopharynx and 79% of the larynx. Mean age at surgery was 63 years (41-90 years). 44% of patients were more than or equal to 65 years of age. Regarding local complications, only age (p = 0.004) had a statistically significant influence in univariate analysis. In multivariate analysis, age (OR 21.4, p = 0.0001) and alcohol consumption (OR 0.18, p = 0.04) were significant. Factors influencing the occurrence of general complications were, in univariate analysis: age >65 years (p = 0.003), type of surgery (p = 0.042), the presence of cardiovascular history (p = 0.47) and ASA score >2 (p = 0.007). In multivariate analysis, only age >65 years remained significant (OR 3.31, p = 0.013).

CONCLUSION

Our results highlight the importance of preoperative oncogeriatric evaluation from the age of 65 years to optimize surgical management.