Importance of long-term preventive tracheotomy as a determining factor in the appearance of tumor recurrences at the tracheostoma in patients laryngectomized for carcinoma

Abstract

In previous investigations the authors have reported a high incidence of recurrences at the level of tracheostoma in patients subjected to total laryngectomy for carcinoma, when the tracheostomy tube was left in place for a long period of time. The present report deals with a large number of cases collected from the National Cancer Institute of Milan and from the Otolaryngology Clinic, University of Milan. A total of 1842 total laryngectomies has been evaluated: stomal recurrences were observed in 63 cases (3.42%). In particular, 18 recurrences occurred among 1578 patients who did not undergo preoperative tracheostomy (1.14 %) and 45 recurrences among 205 patients after long-term use of a tracheostomy tube (21.9%). The lower was the endolaryngeal level of primary carcinoma, the higher was the incidence of recurrence. The length of interval between tracheostomy and laryngectomy influences proportionally the frequency of recurrences (from 16 % for an interval of 10–20 days, to 32 % for an interval higher than 50 days). Although a preoperative thacheostomy may slightly reduce the incidence of mortality due to pulmonary complications, the use of long-term tracheostomy tube is not advisable since it can increase the mortality for recurrent carcinoma of at least 20%.