Pre-operative tracheostomy does not impact on stomal recurrence and overall survival in patients undergoing primary laryngectomy

Abstract

Pre-operative tracheostomy (POT) to secure a critical airway up to several weeks before definitive laryngectomy in patients with laryngeal cancer has been proposed as a risk factor for poor oncologic outcome. Few modern papers, however, examine this question. The aim of this study is therefore to determine whether POT affects oncologic outcome with an emphasis on stomal/peristomal recurrence. This is a retrospective case note review of 60 consecutive patients undergoing curative primary total laryngectomy (TL) for advanced laryngeal squamous cell carcinoma (SCC). Demographic, staging, treatment and outcome data were collected. 27/60 (45 %) patients had POT and 33/60 did not. No patient underwent laser debulking. Median age was 62 years (39-90 years) and median follow-up of survivors was 31 months. 5-year overall survival (OS), disease-specific survival (DSS) and local recurrence-free survival (LRFS) of patients undergoing POT versus no POT was 28 versus 39 % (p = 0.947), 55 versus 46 % (p = 0.201) and 96 versus 88 % (p = 0.324) respectively. No statistically significant difference in OS, DSS and LRFS was found between patients undergoing POT and those not. Despite the relatively small case series, this evidence should reassure surgeons without the ability to perform trans-oral debulking that they should not hesitate to perform tracheostomy on a patient with airway obstruction due to laryngeal cancer. Appropriate definitive treatment meant that POT was not a risk factor for poor oncological outcome in our series.

Oncologic outcomes of total laryngectomy: Impact of margins and preoperative tracheostomy

“…However, many of these articles were quite old, and included patients who had undergone surgery in the 1 or 2 decades before publication. Since then, the adverse impact of preoperative tracheostomy on laryngectomy outcomes has been disputed . However, many of the recent articles could be criticized for having small numbers; reporting on “stomal” recurrences only; not reporting survival outcomes; confining included cases to primary laryngectomies only; nonactuarial statistical methods, and reporting very small numbers of stomal recurrences with which to make statistical comparisons …”

“…Outcomes after total laryngectomy are strongly correlated with disease stage. In particular, nodal status is well established to be a very significant prognosticator . Other important prognostic factors include advanced T classification, poor differentiation, and margin status…”

“…In the past, many studies reported preoperative tracheostomy to be associated with an increased risk of stomal recurrence and reduced survival . However, other authors have disputed the prognostic impact of preoperative tracheostomy …”

“…In particular, nodal status is well established to be a very significant prognosticator. [1][2][3][4] Other important prognostic factors include advanced T classification, poor differentiation, 5 and margin status. 6 The impact of preoperative tracheostomy on local control and survival after total laryngectomy is controversial.…”

“…1,11 However, other authors have disputed the prognostic impact of preoperative tracheostomy. 3,4,[12][13][14] Over the last 20 years, there have been major changes to treatment paradigms for laryngeal cancer. These include a major shift toward primary nonsurgical treatment for most cases of advanced laryngeal cancer, as well as increasing use of laser microsurgery for treatment of early laryngeal cancers with excellent results.…”