Emergency laryngectomy

Abstract

Emergency laryngectomy is a laryngectomy carried out for malignant obstruction of the upper airway within 24 h of admission. This combines relief of the obstruction with definitive primary cancer surgery, and is thought to reduce the risk of post-laryngectomy stomal recurrence. During a 5-year period, 13 patients with upper airway obstruction from squamous cell carcinoma were treated in two departments by emergency laryngectomy. Total laryngectomy was carried out after the diagnosis of squamous cell carcinoma of the larynx (n = 11), or piriform fossa (n = 2), had been confirmed by laryngoscopy and frozen section biopsy. The actuarial 5-year survival was 47%, and no patient in this series developed stomal recurrence. The management of the airway obstruction, and the post-laryngectomy complications, did not differ from those encountered with more conventional treatment. Our experience with this approach suggests that emergency laryngectomy is a satisfactory method of managing airway obstruction due to squamous cell carcinoma of the larynx.

The impact of preoperative tracheotomy on T3 transglottic carcinomas of the larynx

“…An emergency laryngectomy has been reported to decrease the risk of peristomal recurrences and thus improve disease-free intervals [15,18,28]. Consequently, an important issue to clarify is which patients with advanced laryngeal cancer benefit the most from an emergency laryngectomy versus tracheotomy when presenting to a clinician in acute respiratory distress.…”

Emergency laryngectomy

“…It is difficult to understand why both stomal recurrence and mortality are completely eliminated by emergency laryngectomy in some series e.g. that of Wickham et al (1990).…”

“…They carried out two emergency laryngectomies, with no hospital mortality and no stomal recurrence. Several groups have advocated emergency laryngectomy in an effort to avoid stomal recurrence (Bonneau and Lehman, 1975;Myers and Ogura, 1979;Wickham et al, 1990) but only the last authors have reported a series of patients: none of their 13 patients suffered a post-operative death and none had a stomal recurrence. In 1971, we reported a stomal recurrence rate of 21 per cent in 19 patients undergoing tracheostomy before treatment (Stell and van den Broek, 1971).…”

Parastomal Recurrence: A Therapeutic Challenge

“…Keim et al (1), in 1965, implicated the pre-resection tracheostomy as the major factor. This has led to the use of ''emergency laryngectomy'' (37,44,48,62,63) to decrease the chance of tumor cell implantation in the stoma. More recently, in 1996, Fagan and Loock (64) examined the association between pre-resection tracheostomy, as an independent variable, and parastomal recurrence in patients treated using a combination of total laryngectomy and radiotherapy.…”