Peristomal Recurrence: Pathophysiology, Prevention, Treatment

Treatment of the Patient with Upper Airway Obstruction Caused by Cancer of the Larynx

“…It has been shown that viable tumor cells are not spread during tumor vaporization. 20 The experience and efficiency of primary laser debulking of laryngeal tumors, which has caused airway obstruction, has resulted in the patient being able to be evaluated and allowed to give informed consent to further management. [21][22][23][24][25] Intubation and partial excision of the tumor offer several advantages over emergency laryngectomy.…”

Risk factors involved in stomal recurrence following laryngectomy

“…In addition, accurate diagnosis of tumour extent is not possible, and neither is appropriate planning and performance of the operation. A definite indication for emergency tracheostomy can be uncontrolled haemorrhage from a large laryngeal cancer (Davis and Shapshay, 1980), a very rare form of presentation (none of our patients, and not reported in the series available, see Table I). Pre-operative radiotherapy has not proved to be useful: only 2 of the 18 patients treated developed stomal recurrence, but 10 did recur locoregionally!…”

“…The incidence of peristomal recurrence after total laryngectomy has been reported to be 1.7 to 14.7 per cent (Table I), prior tracheostomy being the most commonly found risk factor (Keim et al, 1965;Loewy and Laker, 1968;Condon, 1969;Modlin and Ogura, 1969;Stell and Van der Broek, 1971;Bonneau and Lehman, 1975;Schneider et al, 1975;Batsakis et al, 1976;Myers and Ogura, 1979;Weissman et al, 1979;Davis and Shapshay, 1980;Alvarez-Vicent etal., 1982;Lahoz etal., 1989;Castro et al, 1991). Stomal recurrence has at least five different pathological causes: tumour implanted at the track of a tracheostomy, incompletely excised tumour, a second tumour arising in the tracheal epithelium, paratracheal lymph nodes overlooked at the time of laryngectomy, and a tumour tracking down within the sheath of the sternomastoid muscle (McCombe and Stell, 1991).…”

“…Most of the tumours reported in the different series are bulky, often with subglottic extension, and the patients present with severe respiratory distress and undergo emergency tracheostomy. Exfoliated cells can be obtained from the tumours, but more often there is a direct extension to the thyroid and paratracheal tissues (Norris, 1959;Keim et at., 1965;Modlin and Ogura, 1969;Harrison, 1971;Stell and Van der Broek, 1971;Kirchner et el., 1974;Bonneau and Lehman, 1975;Myers and Ogura, 1979;Davis and Shapshay, 1980;Harrison, 1986). As subglottic tumours and many hypopharyngeal carcinomas metastasize in the paratracheal lymph nodes, some stomal recurrences can be originated by hidden metastases at the time of surgery which simulated posteriorly the clinical picture of a peristomal recurrence (Modlin and Ogura, 1969;Harrison, 1971;Kirchner et al, 1974;Harrison, 1990).…”

Stomal Recurrence after Total Laryngectomy for Squamous Cell Carcinoma of the Larynx

“…The overall rate of stomal recurrence after total laryngectomy ranges from 3% to 15% according to previous reports. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Because the management of stomal recurrence, including chemotherapy, radiotherapy, and surgery, has been reported as unsatisfactory, 3,5,17 attention should be focused on prevention and the early detection of stomal recurrence. Preoperative tracheotomy, 1,4,6,7,10 subglottic invasion, 6,8,10,16 pN, and paratracheal lymph node metastasis [14][15][16] have been suggested as major risk factors for stomal recurrence.…”