Twenty-year experience with salvage total laryngectomy: lessons learned

Abstract

Objective: The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement.

Method: A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed.

Results: Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1-T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent.

Conclusion: More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

Keywords: Chemoradiotherapy; Laryngeal Neoplasms; Laryngectomy; Neck Dissection; Radiotherapy.