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

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. Cancer 2020;126:4905-4916.

Free Flap microvascular pharyngeal closure results in improved dysphagia-specific quality of life following total laryngectomy

“…The 81% 1-year survival among our group was similar to rates demonstrated in previous studies while the 76% 5-year survival was improved in comparison to previous studies [4,20]. Overall rates of surgical complications such as wound infection and wound revision (4% and 15%, respectively) were in keeping with previous studies and in our study, no significant differences were detected between groups [21,22]. Interestingly we observed that median inpatient LOS was reduced among the FF group.…”

Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy

“…8,[30][31][32] Furthermore, there is evidence which suggests that perioperative morbidity is a negative predictor of overall and diseasespecific survival. 33 Although the clinical risk factors associated with PCF formation have been well described, it is unclear whether or not sociodemographic factors, such as age, sex, and race and ethnicity are significantly associated with patient outcomes after total laryngectomy. We found that patients who were female and Hispanic had significantly higher odds of developing PCF.…”

Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy

“…Multiple factors affect the prognosis in patients with laryngeal/hypopharyngeal cancer, most importantly the clinical TNM classification: in patients with increased T and N classifications and with the presence of distant metastases, the survival rate decreases. Boukovalas et al [6] demonstrated that the presence of postoperative complications after primary/salvage TL in laryngeal/hypopharyngeal cancer was associated with poor oncologic outcomes. Several histopathologic features have been reported to be predictive of prognosis, with the presence of ENE being the most important sign of an unfavorable The results demonstrate that the presence of LVI and positive surgical margin were the independent negative prognostic factors of OS, DSS, and DFS among patients who underwent salvage TL after failure of their primary radiation or chemoradiotherapy.…”