Safety and efficacy of functional laryngectomy for end‐stage dysphagia

Topf, Michael C.; Magaña, Linda C; Salmon, Kelly; Hamilton, James; Keane, William M.; Luginbuhl, Adam; Curry, Joseph M.; Cognetti, David M.; Boon, Maurits; Spiegel, Joseph R.

doi:10.1002/lary.26760

Cited by 15 publications

(25 citation statements)

References 31 publications

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“…We report surgical outcomes of laryngectomy that are comparable to those reported previously. 6-9 With 100% recorded patients taking some oral diet (with or without supplemental tube feedings) and 89% with functional tracheoesophageal voice in our series, laryngectomy achieves the goal of safe swallowing without aspiration and with reasonable voice rehabilitation. The relatively high rate of tracheoesophageal voice as compared with prior reports may be reflective of care at a high-volume tertiary care center.…”

Section: Discussionmentioning

confidence: 85%

“…Four other case series in the literature describe total laryngectomy for dysfunctional larynx, ranging from 19 to 32 patients, 6-9 to which we contribute an additional 23 patients. While the other series focused on reporting surgical outcomes, we sought to use a case-control design to identify factors associated with severe dysfunction warranting laryngectomy.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

Goldsmith

Holman

et al. 2020

Otolaryngol.--head neck surg.

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Objective (1) To identify factors associated with severe dysfunctional larynx leading to total laryngectomy after curative treatment of head and neck squamous cell carcinoma and (2) to describe swallowing and voice outcomes. Study Design Retrospective single-institution case-control study. Setting Tertiary care referral center. Methods A 10-year chart review was performed for patients who had previously undergone radiation or chemoradiation for head and neck mucosal squamous cell carcinoma and planned to undergo total laryngectomy for dysfunctional larynx, as well as a control group of matched patients. Controls were patients who had undergone radiation or chemoradiation for mucosal squamous cell carcinoma but did not have severe dysfunction warranting laryngectomy; these were matched to cases by tumor subsite, T stage, and time from last treatment to video swallow study. Main outcomes assessed were postoperative diet, alaryngeal voice, pharyngeal dilations, and complications. Results Twenty-six patients were scheduled for laryngectomy for dysfunctional larynx, of which 23 underwent surgery. Originally treated tumor subsites included the larynx, oropharynx, hypopharynx, oral cavity, and a tumor of unknown origin. The median time from end of cancer treatment to laryngectomy was 11.5 years. All cases were feeding tube or tracheostomy dependent or both prior to laryngectomy. As compared with matched controls, cases were significantly less likely to have undergone IMRT (intensity-modified radiotherapy) and more likely to have pulmonary comorbidities. Eighty-nine percent of cases with follow-up achieved functional alaryngeal voice, and all were able to have oral intake. Conclusion Non-IMRT approaches and pulmonary comorbidities are associated with laryngectomy for dysfunction after radiation or chemoradiation.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

Goldsmith

Holman

et al. 2020

Otolaryngol.--head neck surg.

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“…The damage that RT causes in both malignant and healthy cells leads to several early and late radiotherapyrelated changes. [8][9][10] Early radiation-related changes occur less than 3 months after RT and are caused by direct oxidative stress leading to DNA damage and cell death. 8 Late radiation-related changes are caused by irreversible damage to the vascular supply of the larynx which results in ischemia and fibrosis.…”

Section: Discussionmentioning

confidence: 99%

A Dysfunctional Larynx Dilemma: Carcinoma Recurrence or Radiation-induced Damage?

2022

Acta Med Philipp

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A 61-year-old male diagnosed with laryngeal squamous cell carcinoma presented with hoarseness, progressive dysphagia leading to aspiration, and dyspnea one month after definitive radiation therapy. Examination revealed a diffusely swollen glottis, paralyzed vocal cords, and post-radiation fibrosis. Several glottic biopsies yielded results negative for malignancy and favored radiation-induced changes. When presented with the option of further diagnostic testing with a positron emission tomography (PET) scan or an outright laryngectomy, the patient decided on the latter. Final histopathologic diagnosis was negative for recurrence of malignancy. This case demonstrates treatment dilemmas for patients with laryngeal carcinoma with uncertain recurrence wherein radical surgical management may prove to be a viable option to achieve both diagnostic certainty and ultimate relief of symptoms.

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“…Surgical interventions have also been described for HNC patients with very severe and difficult-to-treat aspiration. In particular, patients with severe OD-related respiratory tract complications may benefit from surgical interventions such as vocal fold medialization techniques in case of vocal fold paralysis [373] (see "Management of oropharyngeal dysphagia as an adverse event and in case of palliation" section), a tracheotomy using cuffed tracheostomy tubes (see "Tracheostomy and oropharyngeal dysphagia in head and neck cancer" and "Complications due to oropharyngeal dysphagia in head and neck cancer" sections), laryngeal suspension surgery [370,375,374], and in selected cases laryngotracheal separation or a TLE [376][377][378][379]. These are, of course, interventions that are considered 'last resort surgical interventions' for the treatment of severe life-threatening OD.…”

Section: Surgical Treatment Of Oropharyngeal Dysphagia In Head and Nementioning

confidence: 99%

“…The number of studies on laryngeal suspension surgery and laryngotracheal separation in HNC patients is very limited and it mainly concerns smaller case series with a low level of evidence [370,[374][375][376]. The body of literature on functional laryngectomy for end-stage OD in HNC patients is slightly more extensive [377][378][379]. These surgical interventions do not guarantee an overall improvement of the swallowing function nor a normalization of oral intake without feeding tube dependency.…”

Section: Surgical Treatment Of Oropharyngeal Dysphagia In Head and Nementioning

confidence: 99%

European white paper: oropharyngeal dysphagia in head and neck cancer

Baijens

Walshe

Aaltonen

et al. 2020

Eur Arch Otorhinolaryngol

103

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Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

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Safety and efficacy of functional laryngectomy for end‐stage dysphagia

Abstract: 4. Laryngoscope, 128:597-602, 2018.

Cited by 15 publications

References 31 publications

Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

Risk Factors for Laryngectomy for Dysfunctional Larynx After Organ Preservation Protocols: A Case‐Control Analysis

A Dysfunctional Larynx Dilemma: Carcinoma Recurrence or Radiation-induced Damage?

European white paper: oropharyngeal dysphagia in head and neck cancer

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