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. 2012 Apr;146(4):585-90.
doi: 10.1177/0194599811432264. Epub 2012 Jan 10.

Outcomes of elective total laryngectomy for laryngopharyngeal dysfunction in disease-free head and neck cancer survivors

Katherine A Hutcheson  1 , Clare P Alvarez, Denise A Barringer, Michael E Kupferman, Peter R Lapine, Jan S Lewin
Affiliations

Outcomes of elective total laryngectomy for laryngopharyngeal dysfunction in disease-free head and neck cancer survivors

Katherine A Hutcheson et al. Otolaryngol Head Neck Surg. 2012 Apr.

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.

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Figures

Figure I
Figure I
Interactions among Indications for Total Laryngectomy
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