Preoperative Tracheostomy Is Associated with Poor Disease-Free Survival in Recurrent Laryngeal Cancer

Abstract

Objectives It is unknown if preoperative tracheostomy for persistent/recurrent laryngeal squamous cell carcinoma (LSCC) plays a role in unrecognized local disease spread and disease recurrence after salvage laryngectomy. The goals of this study were to determine the effect of preoperative tracheostomy on disease-free survival (DFS) in patients with recurrent/persistent LSCC undergoing salvage laryngectomy. Study Design Retrospective case series derived from prospectively maintained database. Setting Tertiary care academic center. Subjects Patients with recurrent/persistent LSCC after radiation/chemoradiation (RT/CRT) who underwent salvage laryngectomy at the University of Michigan from 1997 to 2015. Methods Demographic, clinical, pathologic, and survival data were collected. Kaplan-Meier survival estimates were performed. Results DFS was worse for patients with tracheostomy prior to laryngectomy than patients without a tracheostomy (5 year: 39% vs 67%; P < .001). Patients with tracheostomy prior to RT/CRT compared to patients with tracheostomy after RT/CRT or patients without a tracheostomy had worse DFS (5-year: 25%, 49%, and 67%, respectively; P < .001). In bivariable analyses controlling for T classification, N classification, or overall stage, preoperative tracheostomy was associated with worse DFS. In multivariable analysis, presence of a preoperative tracheostomy had a worse DFS (hazard ratio, 1.63; 95% confidence interval, 1.00-2.67; P = .048). Conclusion Preoperative tracheostomy is associated with disease recurrence in patients with persistent/recurrent LSCC undergoing salvage laryngectomy, particularly in patients who had tracheostomy prior to completion of initial RT/CRT. Notably, preoperative tracheostomy as a causal factor vs marker for disease recurrence is difficult to ascertain. Nevertheless, clinicians should be aware of the increased risk of locoregional recurrence in patients with preoperative tracheostomy when counseling on surgical salvage and when considering the role of additional therapy.

Keywords: laryngeal squamous cell carcinoma; laryngectomy; salvage surgery; survival; tracheostomy.

Figure 1. Survival Stratified by Preoperative Tracheostomy

DFS (A) and locoregional DFS (B) were significantly worse in patients who had a tracheostomy prior to laryngectomy.

Figure 2. Survival Stratified by Timing of Preoperative Tracheostomy

DFS (A), locoregional DFS (B) were worse in patients who had a tracheostomy prior to RT/CRT in comparison to tracheostomy after RT/CRT and no tracheostomy.

Figure 3. Bivariable Analysis of Preoperative Tracheostomy and Survival

Controlling for ypT classification, DFS was worse with tracheostomy(ypT1/T2; 3A; ypT3/T4; 3B). Controlling for overall stage, patients with tracheostomy had worse DFS and locoregional DFS(3C, 3D).