Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-24T09:33:25.850Z Has data issue: false hasContentIssue false
  • English
  • Français

Functional results of pharyngo-laryngectomy and total laryngectomy: a comparison

Published online by Cambridge University Press:  26 August 2011

C Gadepalli ,
C de Casso ,
S Silva ,
S Loughran  and
J J Homer
C Gadepalli
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Science Centre, Manchester Royal Infirmary, University of Manchester, UK
C de Casso
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Science Centre, Manchester Royal Infirmary, University of Manchester, UK
S Silva
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Science Centre, Manchester Royal Infirmary, University of Manchester, UK
S Loughran
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Science Centre, Manchester Royal Infirmary, University of Manchester, UK
J J Homer*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Science Centre, Manchester Royal Infirmary, University of Manchester, UK School of Cancer and Enabling Sciences, University of Manchester, UK
*
Address for correspondence: Mr Jarrod J Homer, Consultant Head and Neck Surgeon/Otolaryngologist, Manchester Royal Infirmary, Oxford Road, Manchester M13 9DL, UK Fax: +44 (0)161 448 0310 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare the key functional results (regarding swallowing and voice rehabilitation) in patients treated by pharyngo-laryngectomy with flap reconstruction, versus standard, wide-field, total laryngectomy.

Method:

We studied 97 patients who had undergone total laryngectomy and pharyngo-laryngectomy with flap reconstruction. The main outcome measures were swallowing (i.e. solid food, soft diet, fluid or enteral feeding) and fluent voice development.

Results:

There were 79 men and 18 women, with follow up of one to 19 years. Voice (p = 0.037) and swallowing (p = 0.041) results were significantly worse after circumferential pharyngo-laryngectomy than after non-circumferential pharyngo-laryngectomy. There was no significant difference in voice (p = 0.23) or swallowing (p = 0.655) results, comparing total laryngectomy and non-circumferential pharyngo-laryngectomy. The presence of a post-operative fistula significantly influenced voice (p = 0.001) and swallowing (p = 0.009) outcomes.

Conclusion:

The additional measures involved in pharyngo-laryngectomy do not confer any functional disadvantage, compared with total laryngectomy, but only if the procedure is non-circumferential. Functional results of circumferential pharyngo-laryngectomy are worse than those of both non-circumferential pharyngo-laryngectomy and total laryngectomy. If oncologically possible and safe, it is better to keep a pharyngo-laryngectomy non-circumferential.

Keywords

VoiceSwallowingLaryngectomyPharyngectomyCarcinoma
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 1 , January 2012 , pp. 52 - 57
Copyright
Copyright © JLO (1984) Limited 2011

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 ENT-UK Annual Conference, 10 September 2010, Coventry, UK

References

1Clark, JR, Gilbert, R, Irish, J, Brown, D, Neligan, P, Gullane, PJ. Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope 2006;116:173–81Google Scholar
2Woodard, TD, Oplatek, A, Petruzzelli, GJ. Life after total laryngectomy: a measure of long-term survival, function, and quality of life. Arch Otolaryngol Head Neck Surg 2007;133:526–32Google Scholar
3de Casso, C, Slevin, NJ, Homer, JJ. The impact of radiotherapy on swallowing and speech in patients who undergo total laryngectomy. Otolaryngol Head Neck Surg 2008;139:792–7Google Scholar
4Chen, AY, Frankowski, R, Bishop-Leone, J, Hebert, T, Leyk, S, Lewin, J et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 2001;127:870–6Google ScholarPubMed
5Williams, LR, Kasir, D, Penny, S, Homer, JJ, Laasch, HU. Radiological balloon dilatation of post-treatment benign pharyngeal strictures. J Laryngol Otol 2009;123:1229–32CrossRefGoogle ScholarPubMed
6Theile, DR, Robinson, DW, Theile, DE, Coman, WB. Free jejunal interposition reconstruction after pharyngolaryngectomy: 201 consecutive cases. Head Neck 1995;17:83–8CrossRefGoogle ScholarPubMed
7Lewin, JS, Barringer, DA, May, AH, Gillenwater, AM, Arnold, KA, Roberts, DB et al. Functional outcomes after circumferential pharyngoesophageal reconstruction. Laryngoscope 2005;115:1266–71Google Scholar
8Varvares, MA, Cheney, ML, Gliklich, RE, Boyd, JM, Goldsmith, T, Lazor, J et al. Use of the radial forearm fasciocutaneous free flap and Montgomery salivary bypass tube for pharyngoesophageal reconstruction. Head Neck 2000;22:463–8Google Scholar
9Murray, DJ, Gilbert, RW, Vesely, MJ, Novak, CB, Zaitlin-Gencher, S, Clark, JR et al. Functional outcomes and donor site morbidity following circumferential pharyngoesophageal reconstruction using an anterolateral thigh flap and salivary bypass tube. Head Neck 2007;29:147–54CrossRefGoogle ScholarPubMed
10Merve, A, Mitra, I, Swindell, R, Homer, JJ. Shoulder morbidity after pectoralis major flap reconstruction for head and neck cancer. Head Neck 2009;31:1470–6CrossRefGoogle ScholarPubMed
11Yu, P, Hanasono, MM, Skoracki, RJ, Baumann, DP, Lewin, JS, Weber, RS et al. Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer 2010;116:1718–24Google Scholar