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with the registry data. The present study was undertaken to confirm the national database findings and better understand patients' decision process. Materials/Methods: Adult patients with stage II-IVa laryngeal squamous cell carcinoma diagnosed from 2006-2014 were identified from an institutional cancer database. Demographic and oncologic data were obtained from the database, then confirmed and augmented via comprehensive chart review. Patients who did not undergo curative treatment were excluded. Patients refusing laryngectomy in favor of chemoradiation were compared to those receiving surgery using paired t-tests and chi-squared tests for continuous and categorical variables, respectively. Patients refusing laryngectomy were then matched to those undergoing laryngectomy using propensity scoring with a 1:3 case:control ratio. Kaplan-Meier curves were developed for overall survival and compared by log-rank testing. Results: The study cohort consisted of 141 patients with median of 67 months follow-up. Six patients were identified as refusing surgery from registry data and an additional 3 from chart reviews, representing 12.6% refusal among 70 patients recommended surgery. Compared to patients undergoing laryngectomy, the 9 refusing patients were more often black (66.7% vs 18.0%, PZ.006), female (55.6% vs 26.2%, PZ.161) and current alcohol users (88.9% vs 44.3%, PZ.086). Age, subsite, and comorbidities were similar between groups. Overall survival curves were similar between patients refusing laryngectomy and matched controls (median 69 vs 51 months, PZ.470). Reasons for refusing laryngectomy included fear of surgery, uncertainty of recovery, and a stated desire to avoid a permanent stoma. Conclusion: Many patients who may benefit from laryngectomy are apprehensive about surgery, and a subset will refuse this treatment despite the recommendation of their treatment teams. After controlling for potential confounding factors, including those not available in prior registryderived studies, no survival difference was found associated with refusal.

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