Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-24T11:28:53.387Z Has data issue: false hasContentIssue false
  • English
  • Français

Analysis of oncological and functional failures following near-total laryngectomy

Published online by Cambridge University Press:  18 June 2008

A Thakar ,
S Bahadur ,
K C Toran ,
B K Mohanti  and
P K Julka
A Thakar*
Affiliation:
Department of Otolaryngology and Department of Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
S Bahadur
Affiliation:
Department of Otolaryngology and Department of Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
K C Toran
Affiliation:
Department of Otolaryngology and Department of Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
B K Mohanti
Affiliation:
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
P K Julka
Affiliation:
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
*
Address for correspondence: Dr A Thakar, Associate Professor of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. Fax: +91 11 26588663 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To improve case selection for near-total laryngectomy by identifying the causes of poor oncological and functional outcomes.

Methods:

Analysis of prospectively accrued data for 28 consecutive cases of near-total laryngectomy undertaken between 1996 and 2005 at a tertiary care centre. We analysed the impact of tumour extent and location, patient physiological status, and surgical technique on disease-free survival and on functional outcome.

Results:

Patients' average four-year Kaplan–Meier disease-free survival was 74 per cent (95 per cent confidence intervals, 46–89 per cent). Eighty-two per cent of patients had good to excellent functional outcomes. Pre-operative tumour extension to the ipsilateral arytenoid significantly compromised disease-free survival (patients with this development had a two-year survival of 40 per cent; p = 0.001). Internal communicating fistula formation (i.e. a fistula between the neopharynx and myomucosal shunt lumens) occurred in five of 28 cases and was uniformly associated with a poor functional outcome (i.e. lack of phonation with or without aspiration). Fistula formation was significantly more likely in cases with tumour involving the ipsilateral arytenoid and the ipsilateral subglottis.

Conclusions:

Significant disparity exists for the functional outcome of near-total laryngectomy in patients who develop post-surgical internal fistula, compared with those with uneventful healing. Tumour involvement of the ipsilateral arytenoid compromises the oncological and functional results. Tumour extension to the subglottis may compromise functional outcome. Near-total laryngectomy should be avoided in cases with ipsilateral arytenoid involvement, and undertaken with caution in cases with subglottic extension.

Keywords

Larynx NeoplasmsLaryngectomyOtorhinolaryngologic Surgical Procedure
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 3 , March 2009 , pp. 327 - 332
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the 6th European Congress of Otolaryngological Societies, June 30–July 4, 2007, Vienna, Austria.

References

1 Pearson, BW. Subtotal laryngectomy. Laryngoscope 1981;91:1904–11CrossRefGoogle ScholarPubMed
2 Pearson, BW, DeSanto, LW, Olsen, KD, Salassa, JR. Results of near-total laryngectomy. Ann Otol Rhinol Laryngol 1998;107:820–5CrossRefGoogle ScholarPubMed
3 Shenoy, AM, Plinkert, PK, Nanjundappa, N, Premalata, S, Arunodhay, GR. Functional utility and oncologic safety of near-total laryngectomy with tracheopharyngeal speech shunt in a Third World oncologic center. Eur Arch Otorhinolaryngol 1997;254:128–32CrossRefGoogle Scholar
4 Andrade, RP, Kowalski, LP, Vieira, LJ, Santos, CR. Survival and functional results of Pearson's near-total laryngectomy for larynx and pyriform sinus carcinoma. Head Neck 2000;22:12–163.0.CO;2-K>CrossRefGoogle ScholarPubMed
5 Pradhan, SA, D'Cruz, AK, Pai, PS, Mohiyuddin, A. Near-total laryngectomy in advanced laryngeal and pyriform cancers. Laryngoscope 2002;112:375–80CrossRefGoogle ScholarPubMed
6 Aslan, I, Baserer, N, Yazicioglu, E, Oysu, C, Tinaz, M, Kiyak, E et al. Near-total laryngectomy for laryngeal carcinomas with subglottic extension. Arch Otolaryngol Head Neck Surg 2002;128:177–80CrossRefGoogle ScholarPubMed
7 Calder, N, MacArdle, C, MacGregor, F. Tracheoesophageal voice prostheses complications in north Glasgow. J Laryngol Otol 2006;120:487–92CrossRefGoogle ScholarPubMed
8 Shenoy, AM, Ashok, H, Premalata, BS, Prasad, AV, Nanjundappa, K, Kumar, S. Surgical speech restoration by tracheo-oesophageal puncture – Kidwai experience. Indian J Cancer 2000;37:27–31Google ScholarPubMed
9 Thakar, A, Bahadur, S. Troubleshooting with the tracheo-esophageal prosthesis. Indian J Otolaryngol Head Neck Surg 2002;54:27–9CrossRefGoogle Scholar
10 Perry, A, Shaw, M. Evaluation of functional outcomes (speech, swallowing and voice) in patients attending speech pathology after head and neck cancer treatment(s): development of a multi-centre database. J Laryngol Otol 2000;114:605–15CrossRefGoogle ScholarPubMed
11 Gavilan, J, Herranz, J, Prim, J, Rabanal, I. Speech results and complications of near-total laryngectomy. Ann Otol Rhinol Laryngol 1996;105:729–33CrossRefGoogle ScholarPubMed
12 Bernaldez, R, Garcia-Pallares, M, Morera, E, Lassaletta, L, Del Palacio, A, Gavilan, J. Oncologic and functional results of near-total laryngectomy. Otolaryngol Head Neck Surg 2003;128:700–5CrossRefGoogle ScholarPubMed
13 Maamoun, SI, Amira, G, Younis, A. Near total laryngectomy: a versatile approach for voice restoration in advanced T3 and T4 laryngeal cancer: functional results and survival. J Egypt Natl Canc Inst 2004;16:15–21Google ScholarPubMed
14 Wang, XL, Xu, ZG, Tang, PZ. Surgical treatment on primary lesion of advanced pyriform sinus cancer [in Chinese]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2006;28:534–7Google ScholarPubMed
15 Suits, GW, Cohen, JI, Everts, EC. Near-total laryngectomy. Patient selection and technical considerations. Arch Otolaryngol Head Neck Surg 1996;122:473–5CrossRefGoogle ScholarPubMed
16 Pearson, BW. Near-total laryngectomy. In: Cummings, CW, Fredrickson, JM, eds. Otolaryngology – Head and Neck Surgery. St Louis: CV Mosby, 1986;3:2117–32Google Scholar
17 Brennan, JA, Mao, L, Hruban, RH, Boyle, JO, Eby, YJ, Koch, WM et al. Molecular assessment of histopathological staging in squamous-cell carcinoma of the head and neck. N Eng J Med 1995;332:429–35CrossRefGoogle ScholarPubMed