Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10‐year retrospective longitudinal study in Eastern Denmark

Wulff, Nille Birk; Kristensen, Claus Andrup; Andersen, Elo; Charabi, Birgitte; Sørensen, Christian Hjort; Homøe, Preben

doi:10.1111/coa.12443

Cited by 27 publications

(17 citation statements)

References 25 publications

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“…Wound complications (specifically PCFs) and hematomas are well recognized as the most common complications in primary and salvage TL . This study found a strong association between wound complications and both current and former smokers, and its findings support prior evidence linking smoking to overall complications and PCFs in TL . Despite the clinically apparent negative impact of smoking on wound healing, a recent systematic analysis of smoking and perioperative complications in head and neck cancer found mixed results, largely because of the heterogeneity of the studies in terms of methodology, smoking classification, and outcomes of interest.…”

Section: Discussionsupporting

confidence: 70%

“…[16][17][18] This study found a strong association between wound complications and both current and former smokers, and its findings support prior evidence linking smoking to overall complications and PCFs in TL. 19 Despite the clinically apparent negative impact of smoking on wound healing, a recent systematic analysis of smoking and perioperative complications in head and neck cancer found mixed results, largely because of the heterogeneity of the studies in terms of methodology, smoking classification, and outcomes of interest. Nevertheless, this association is supported by strong physiologic plausibility and evidence of relative tissue hypoxemia in current and/or recent smokers as well as knowledge of common comorbidities among smokers that negatively affect wound healing.…”

Section: Discussionmentioning

confidence: 99%

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Complications, hospital length of stay, and readmission after total laryngectomy

Goepfert

Hutcheson

Lewin

et al. 2016

Cancer

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Background The purpose of this study was to describe the 30-day incidence of complications after total laryngectomy (TL) in a high-volume institution and their impact on hospital length of stay (LOS) and readmission rates. Methods A retrospective, cohort study of all patients who underwent TL at MD Anderson Cancer Center from January 1, 2010 through June 30, 2013 was conducted. Patient demographics, treatment history, LOS, and 30-day post-TL complications and readmissions were extracted from the medical record. Univariate associations were analyzed and stepwise backward selection methods were used to fit multivariate models. Results 245 patients were included. Complications occurred in 83 patients (33.9%) including 3 (1.2%) deaths. Wound complications occurred in 53 patients (21.6%), of which 34 were pharyngocutaneous fistula (PCF) (13.9% overall). 34 patients (13.9%) were readmitted within 30 days. Multivariate analysis revealed the following: wound complications were associated with former (OR 5.1, p=0.03) and current (OR 5.8, p=0.02) smokers; PCF was associated with prior wide-field radiation (OR 3.1, p=0.01) but not prior narrow-field (larynx only) radiation (OR 1.4, p=0.61); LOS was associated with type of flap (p=0.002) and post-operative hematoma (p=0.05); and readmissions were associated with pre-operative hypoalbuminemia (p=0.003) and post-operative wound complications (p<0.001). Conclusions Complications occurred in nearly one third of TL patients, particularly among patients with poor wound healing risk factors such as prior smoking and radiation. Expectedly, LOS was longer among reconstructed patients. Readmission was associated with hypoalbuminemia and post-operative wound complications. These data inform quality improvement efforts and counseling of high-risk patients undergoing TL.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Complications, hospital length of stay, and readmission after total laryngectomy

Goepfert

Hutcheson

Lewin

et al. 2016

Cancer

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mentioning

confidence: 99%

“…We have previously demonstrated that preoperative current smoking, chronic obstructive pulmonary disease, tumour localisation in the hypopharynx and residual or recurrent tumour following surgery are factors associated with complications after salvage TL. 7 Only a few studies have investigated the prognostic factors for survival following salvage TL, and this study represents one of the largest from a single institution.…”

mentioning

confidence: 99%

Prognostic factors for survival after salvage total laryngectomy following radiotherapy or chemoradiation failure: a 10‐year retrospective longitudinal study in eastern Denmark

Wulff

Andersen²,

Kristensen³

et al. 2016

Clinical Otolaryngology

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Our overall survival, disease-specific survival and disease-free survival findings are in accordance with previous studies. With the purpose of identifying recurrent tumour, we suggest extra attention being given to patients with higher N classification and need for lymph node excision during salvage total laryngectomy along with use of frozen sections. The high number of patients with recurrence within 1 year after salvage total laryngectomy occurred although thorough and regular follow-up visits were performed.

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“…Although there may be some debate regarding the optimal treatment for locally advanced laryngeal cancer, there is agreement that comorbidities play an important role in guiding treatment decisions and outcomes. Multiple studies have demonstrated that the primary predictor of complications after a TL is a salvage setting after RT or CRT failure . Several large database reviews have more recently identified specific comorbidities that are associated with increased complications or readmissions after a TL .…”

Section: Discussionmentioning

confidence: 99%

Effect of medical comorbidities on treatment regimen and survival in T3/T4 laryngeal cancer

2019

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Objective: Investigate the impact of medical comorbidities on treatment regimen and overall survival (OS) in patients with locally advanced laryngeal cancer.Study Design: Retrospective Review of the National Cancer Database (NCDB). Methods: The NCDB was queried for patients with T3 and T4 laryngeal cancer. Comorbidity scores were calculated from the Charlson-Deyo comorbidity index (CDCI). Univariate and multivariate analyses explored the association of CDCI scores on treatment regimen and OS.Results: 14,053 patients were analyzed. 65% of patients had a CDCI score of 0, whereas 25%, 7%, and 3% had CDCI score of 1, 2, and ≥3, respectively. As patients' CDCI increased, they became more likely to receive treatment options other than a laryngectomy or chemoradiation therapy (CRT) (P < 0.0001). Patients with CDCI ≥1 were more likely have a laryngectomy than those with CDCI 0 (P < 0.0001). In patients with T3 tumors, OS did not differ between those receiving CRT versus laryngectomy with any CDCI score. In patients with T4 tumors, laryngectomy was associated with improved OS compared to CRT across all CDCI scores except CDCI ≥3.Conclusion: Our results support the current national guidelines with a recommendation for CRT or TL for T3 tumors and a preference for TL for T4 tumors. These outcomes are generally consistent in patients as their CDCI scores increases.

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Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10‐year retrospective longitudinal study in Eastern Denmark

Cited by 27 publications

References 25 publications

Complications, hospital length of stay, and readmission after total laryngectomy

Complications, hospital length of stay, and readmission after total laryngectomy

Prognostic factors for survival after salvage total laryngectomy following radiotherapy or chemoradiation failure: a 10‐year retrospective longitudinal study in eastern Denmark

Effect of medical comorbidities on treatment regimen and survival in T3/T4 laryngeal cancer

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