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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: meenaal@vsnl.com
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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

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Footnotes

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

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