Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 15;126(22):4905-4916.
doi: 10.1002/cncr.33185. Epub 2020 Sep 15.

Association between postoperative complications and long-term oncologic outcomes following total laryngectomy: 10-year experience at MD Anderson Cancer Center

Stefanos Boukovalas  1 , Ryan P Goepfert  2 , J Michael Smith  3 , Elise Mecham  4 , Jun Liu  1 , Mark E Zafereo  2 , Edward I Chang  1 , Amy C Hessel  2 , Matthew M Hanasono  1 , Neil D Gross  2 , Peirong Yu  1 , Jan S Lewin  2 , Carol M Lewis  2 , Eduardo M Diaz Jr  2 , Randal S Weber  2 , Jeffrey N Myers  2 , Anaeze C Offodile 2nd  1   5   6
Affiliations
Free article

Association between postoperative complications and long-term oncologic outcomes following total laryngectomy: 10-year experience at MD Anderson Cancer Center

Stefanos Boukovalas et al. Cancer. .
Free article

Abstract

Background: Postoperative complications are an independent predictor of poor survival across several tumors. However, there is limited literature on the association between postoperative morbidity and long-term survival following total laryngectomy (TL) for cancer.

Methods: We conducted a retrospective review of all TL patients at a single institution from 2008 to 2013. Demographic and clinical data were collected and analyzed, including postsurgical outcomes, which were classified using the Clavien-Dindo system. Multivariable Cox regression analyses were performed to identify factors associated with overall survival (OS) and disease-free survival (DFS).

Results: A total of 362 patients were identified. The mean age was 64 years, and the majority of patients were male (81%). The median follow-up interval was 21 months. Fifty-seven percent of patients had received preoperative radiation, and 40% had received preoperative chemotherapy. Fifty-seven percent of patients underwent salvage TL, and 60% underwent advanced reconstruction (45% free flap and 15% pedicled flap). A total of 136 patients (37.6%) developed postoperative complications, 92 (25.4%) of which were major. Multivariable modeling demonstrated that postoperative complications independently predicted shorter OS (hazard ratio [HR], 1.50; 95% CI, 1.16-1.96; P = .002) and DFS (HR, 1.36; 95% CI, 1.05-1.76; P = .021). Other independent negative predictors of OS and DFS included positive lymph node status, preoperative chemotherapy, comorbidity grade, and delayed adjuvant therapy. Severity of complication and reason for TL (salvage vs primary) were not shown to be predictive of OS or DFS.

Conclusion: Postoperative complications are associated with worse long-term OS and DFS relative to uncomplicated cases. Patient optimization and timely management of postoperative complications may play a critical role in long-term survival.

Keywords: laryngeal cancer; laryngeal reconstruction; postoperative complications; survival; total laryngectomy.

PubMed Disclaimer

References

    1. Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324:1685-1690.
    1. Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;31:845-852.
    1. Klozar J, Cada Z, Koslabova E. Complications of total laryngectomy in the era of chemoradiation. Eur Arch Otorhinolaryngol. 2012;269:289-293.
    1. Leong SC, Kartha SS, Kathan C, Sharp J, Mortimore S. Outcomes following total laryngectomy for squamous cell carcinoma: one centre experience. Eur Ann Otorhinolaryngol Head Neck Dis. 2012;129:302-307.
    1. van der Putten L, de Bree R, Kuik DJ, Rietveld DH, Buter J, Eerenstein SE, et al. Salvage laryngectomy: oncological and functional outcome. Oral Oncol. 2011;47:296-301.

LinkOut - more resources