Preoperative Tracheostomy Is Associated with Poor Disease‐Free Survival in Recurrent Laryngeal Cancer

Abstract

Objectives It is unknown if preoperative tracheostomy for persistent/recurrent laryngeal squamous cell carcinoma(LSCC) plays a role in unrecognized local disease spread and disease recurrence after salvage laryngectomy. The goals of this study were to determine the effect of preoperative tracheostomy on disease-free survival(DFS) in patients with recurrent/persistent LSCC undergoing salvage laryngectomy. Study Design Retrospective case series derived from prospectively maintained database. Setting Tertiary care academic center. Subjects Patients with recurrent/persistent LSCC after radiation/chemoradiation (RT/CRT) who underwent salvage laryngectomy at the University of Michigan from 1997–2015. Methods Demographic, clinical, pathologic, and survival data were collected. Kaplan-Meier survival estimates were performed. Results DFS was worse for patients with tracheostomy prior to laryngectomy than patients without a tracheostomy(5 year: 39% vs. 67%;p<0.001). Patients with tracheostomy prior to RT/CRT compared to patients with tracheostomy after RT/CRT or patients without a tracheostomy had worse DFS(5-year: 25%, 49% and 67% respectively;p < 0.001). In bivariable analyses controlling for T classification, N classification or overall stage, preoperative tracheostomy was associated with worse DFS. In multivariable analysis, presence of a preoperative tracheostomy had a worse DFS(HR: 1.63;95% CI 1.00–2.67; p=0.048). Conclusion Preoperative tracheostomy is associated with disease recurrence in patients with persistent/recurrent LSCC undergoing salvage laryngectomy, particularly in patients who had tracheostomy prior to completion of initial RT/CRT. Notably, preoperative tracheostomy as a causal factor versus marker for disease recurrence is difficult to ascertain. Nevertheless, clinicians should be aware of the increased risk of locoregional recurrence in patients with preoperative tracheostomy when counseling on surgical salvage, and when considering the role of additional therapy.

Proportion of CD4 and CD8 tumor infiltrating lymphocytes predicts survival in persistent/recurrent laryngeal squamous cell carcinoma

“…We then analyzed the effect of demographic and clinical factors (Table 1) on prognosis. We verified that our cohort of patients with advanced T classification and recurrent nodal positivity had worse OS, DSS, and DFS, as we had previously described, and in line with previous investigations (1,5,10,18,19).…”

<p>Effects of Anesthetic Technique on Postoperative Pulmonary Metastasis in Patients Undergoing Laryngectomy</p>

“…26 , 27 However, we found no independent risk factors for stomal recurrence statistically, which could be explained with the limited sample size that matched by similar propensity scores. We also suspect that the patients who had preoperative tracheostomy has poor disease-free survival, 28 which would make it more difficult to follow up patients and focus enough on tracheostomal recurrence.…”

Acute presentation of a partially obstructing laryngeal tumour: adjuvant agents to gaseous induction of anaesthesia

“…However, the procedure alone could lead to tumour seeding, thus, worsening the prognosis of the patient 3. Although the priority is to secure the airway as safely as possible, consideration needs to be given to the overall treatment aim.…”