Tracheal Autotransplantation for Functional Reconstruction of Extended Hemilaryngectomy Defects: A Single-Center Experience in 30 Patients

Abstract

Background: Tracheal autotransplantation is a reconstructive technique that allows for organ-sparing treatment of selected patients with advanced cricoid cartilage chondrosarcoma and T2 or T3 laryngeal squamous cell carcinoma (SCC) (unilateral T2 with impaired vocal fold mobility; T3 with subglottic extension and/or arytenoid cartilage fixation). This study evaluated the functional and oncologic outcomes of an optimized autotransplant technique that the authors have been using since 2003.

Methods: The study retrospectively reviewed the charts of all patients who underwent tracheal autotransplantation at the authors' center between 2003 and 2015.

Results: The cohort included 30 patients: 7 with cricoid chondrosarcoma and 23 with laryngeal SCC. The median age of the patients was 60.5 years. The median follow-up period was 78 months. The 3- and 5-year overall survival rates were respectively 92 and 80 %, and the cause-specific survival rates were respectively 100 and 96 %. Only one patient experienced tumor recurrence. The temporary tracheostomy was closed in 22 patients (73 %). The laryngeal preservation rate was 90 %, with 25 patients (83 %) obtaining a functional voice and 25 patients (83 %) resuming normal oral feeding. The univariate analysis showed advanced age (>65 years) as a negative prognostic factor for functional outcome but exhibited no statistical influence of gender, tumor type or stage, or previous radiotherapy. Strikingly, all chondrosarcoma patients experienced optimal functional outcomes.

Conclusion: For this particular group of patients, the authors' tracheal autotransplantation technique provides excellent functional results for respiration, speech, and swallowing without compromising the oncologic outcome. This is particularly true for patients younger than 65 years and for those with cricoid chondrosarcoma.