Abstract
Abstract The development of tracheostomerecurrence after total laryngectomy is a complication with a dismal prognosis. The average survival rate of tracheostome recurrence (TR) is 7.5%, ranging from 1.7% to 40%The TR consists of diffuse infiltration of tumor into the soft tissues of the neck and mediastinum; hence the control of this disease is difficult. To analyze the impact of preoperative tracheostomy ontracheostome recurrence (TR), regional recurrence (RR), and overall survival (OS) in patients undergoing primary laryngectomy. Thirty three consecutive patients, who underwent primary total laryngectomy for locally advancedlaryngeal squamous cell carcinoma, were enrolled in this study. Patients whounderwent primary chemo-radiotherapy, partial laryngectomyor those treated palliatively wereexcluded from the study. Patient factors analyzed included age, gender, primarytumor site, TNM classification, type of procedure, thyroid gland management, extent of neck dissection and preoperative tracheostomy (POT). The timeinterval between tracheostomy and definitive surgery was calculated. A total of 33 patients underwent total laryngectomy(TL) for squamous cell carcinoma of the larynx. Thirty patients (90.9%) were males, while 3 (9.1%) patients were females. Their mean age was 57.7 (±11.6) years, 26 (78.8%) of them were smokers, their follow up mean time was 23 (±6.6) months. Tracheostomy recurrence occurred in 3 (9.1%) patients and regional recurrence in another 3(9.1%) patients. The 2 years survivalfor the whole patients was 84.8% and overall survival was 81.1%. Nineteen patients had POTbetween 10 to 21days (median 15)prior to TL surgery. Fourteen patients had their tracheostomy at the time of surgery. There was no statistical significant difference between both groups as regard overall survival, stomal recurrence and regional recurrence. Our results are in keeping with more recent studies, which suggest that POT is notnecessarily related to stomal recurrence or poor oncological outcome.
Highlights
Tracheostome recurrence (TR) following primary total laryngectomy (TL) for squamous cell carcinoma (SCC) occurs in 2–15% [1,2] and has been defined as ‘a diffuse infiltration of neoplastic tissue at the junction of the trachea and skin’ [1]
We present our experience with a series of laryngectomy patients, with the aim of analyzing the impact of preoperative tracheostomy (POT) on tracheostome recurrence (TR), regional recurrence, and overall survival (OS) in patients undergoing primary laryngectomy
Kaplan–Meier survival curves for stomal recurrence and regional recurrence in the IOT and POT groups showed that there was no statistically significant difference between the two groups (Figs. 2 and 3) and (Table 3)
Summary
Tracheostome recurrence (TR) following primary total laryngectomy (TL) for squamous cell carcinoma (SCC) occurs in 2–15% [1,2] and has been defined as ‘a diffuse infiltration of neoplastic tissue at the junction of the trachea and skin’ [1]. It is associated with very poor prognosis despite aggressive surgery or radiotherapy. Most cases are diagnosed within the first year following TL, but some cases present as late as 3.5 years after surgery [4] It is associated with 90% mortality, with more than 80% of the patients dying within the first 24 months [5]. The development of tracheostomerecurrence after total laryngectomy is a complication with a dismal prognosis .The average survival rate of tracheostome recurrence (TR) is 7.5%, ranging from 1.7% to 40%The TR consists of diffuse insltration of tumor into the soft tissues of the neck and mediastinum; the control of this disease is difscult
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