Outcomes following total laryngectomy for squamous cell carcinoma: one centre experience

Abstract

Objectives: To evaluate the clinical outcomes of total laryngectomy (TL), complications and factors affecting survival.

Design: Retrospective review of hospital electronic database for head and neck squamous cell carcinoma (SCCa).

Setting: Large district general hospital in England, United Kingdom.

Participants: Patients who had TL between January 1994 and January 2008.

Main outcome measures: 5-year disease specific survival (DSS) and disease-free survival (DFS).

Results and conclusions: Seventy-one patients were reviewed, of whom 38 (54%) had laryngeal SCCa and 33 (46%) hypopharyngeal SCCa. The overall mean survival period following TL was 42.4 months. The 5-year DSS and DFS was better for laryngeal SCCa compared to hypopharyngeal SCCa, although not statistically significant (P=0.090, P=0.54 respectively). Patients treated for laryngeal SCCa had a mean survival period of 47.5 months compared to 36.5 months for hypopharyngeal disease. Those who had laryngeal recurrence after primary radiotherapy (RT) demonstrated statistically better survival probability than those who had hypopharyngeal recurrence (P=0.011). Patients without cervical lymphadenopathy had statistically better survival (P=0.049). The most common early complication was related to the cardiorespiratory system. One fatal complication of erosion of the brachiocephalic artery due to the laryngectomy tube was noted. The most common late complication was neopharyngeal stenosis. The commonest cause of death was due to locoregional recurrence, followed by medical co-morbidities. Patients referred to specialised head and neck clinic had a better survival probability than those referred to a general ENT clinic (P=0.37). While there is increasing tendency towards laryngeal conservation, total laryngectomy remains a robust treatment option in selected patients.