Total Laryngectomy for a Dysfunctional Larynx After (Chemo)Radiotherapy

Abstract

Objective: To evaluate the functional outcomes after total laryngectomy (TLE) for a dysfunctional larynx in patients with head and neck cancer that is in complete remission after (chemo)radiotherapy.Design: Retrospective cohort study.Setting: Tertiary comprehensive cancer center. Patients:The study included 25 patients from a cohort of 217 consecutive patients with TLE who were treated between January 2000 and July 2010. The inclusion criteria for this subgroup analysis were complete remission and functional problems for which TLE was considered to be the only resolution. Quality of life assessment was carried out using the European Organization for Research and Treatment of Cancer Quality of Life C30 and Head and Neck Module 35 questionnaires and an additional study-specific questionnaire covering functional aspects, such as swallowing and dyspnea, in more detail.Intervention: Total laryngectomy.Main Outcome Measures: Morbidity, mortality, and functional outcomes. Results:The indication for TLE was chronic aspiration with or without recurrent pneumonia (n = 15 [60%]), debilitating dyspnea (n = 8 [32%]), and persistent profuse hemorrhage (radiation ulcer) (n = 2 [8%]). After TLE, 14 of the 25 patients (56%) had 20 major postoperative complications, including 11 pharyngocutaneous fistulas, requiring additional treatment. Tube feeding and recurrent pneumonia incidence had decreased from 80% and 28% to 29% and 0%, respectively, 2 years after surgery. Prosthetic voice rehabilitation was possible in 19 patients (76%). Two years after surgery, 10 of 14 patients (71%) still reported TLE-related pulmonary problems despite the consistent use of a heat and moisture exchanger. The 5-year overall survival rate was 35%. Conclusions:Total laryngectomy for a dysfunctional larynx tends to have a high complication rate. However, in this study, the initial functional problems (aspiration, recurrent pneumonia, and dyspnea) did not recur. Tube feeding was significantly reduced, and the quality of life of the surviving patients appeared to be reasonable.

T3‐T4 laryngeal cancer in The Netherlands Cancer Institute; 10‐year results of the consistent application of an organ‐preserving/‐sacrificing protocol

“…Especially through preservation of the salivary glands, the reduction of xerostomia leads to less severe dysphagia. Nevertheless, in some cases, a total laryngectomy is still deemed to be the only solution to resolve the sequels of (C)RT, as recently published from our institute, where 11% of the total laryngectomies over the last decade was indicated for a “dysfunctional larynx.” It should be noted that, in that study, all patients previously treated with RT or CRT for any head and neck cancer site were included. In the present study, the 5‐year laryngectomy‐free interval was 72% after RT and 83% after CRT.…”

Trends in treatment and survival for advanced laryngeal cancer: A 20‐year population‐based study in The Netherlands

“…12,13 Furthermore, the function of the larynx, especially its vital role in aspiration prevention, can become so impaired that some patients require a total laryngectomy because of a dysfunctional larynx after prior RT or CRT. 14 In The Netherlands, there are 2 unique databases for cancer: the Netherlands Cancer Registry (NCR) and the PALGA foundation database (the nationwide network and registry of histopathology and cytopathology in The Netherlands 15 ). Combining these 2 databases now makes it possible to conduct a population-based cohort study on advanced laryngeal cancer with the following research questions.…”

Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer

“…Primary chemoradiotherapy for advanced laryngeal cancer has become the standard of care in many institutions in the United States, achieving cure rates similar to that of total laryngectomy followed by radiotherapy . Successfully performing salvage total laryngectomy in patients with tissue damage from chemoradiotherapy has, therefore, become an evolving aspect in the management of advanced laryngeal cancer . After salvage, total laryngectomy defects can be classified into 3 general categories, namely those with sufficient mucosa to close primarily, those with mucosa present but insufficient to close requiring “patch” reconstruction, and those requiring total laryngopharyngectomy with a tubed reconstruction.…”

“…Since that time, the laryngectomy population itself has changed dramatically. With the advent of organ‐preservation protocols as a treatment method for advanced laryngeal cancer, total laryngectomy is now a procedure that tends to be reserved for recurrences, persistent disease, those with more advanced cancer, or those with a “dysfunctional larynx” after chemoradiation . As a result, the rate of total laryngectomy has dropped consistent with a trend toward nonsurgical treatment .…”