Salvage Laryngectomy Outcomes in Recurrent Laryngeal Cancer

Abstract

Objective: To investigate the effectiveness of salvage partial laryngectomy (PL) and total laryngectomy (TL) in the treatment of recurrent laryngeal cancer in terms of disease control, postoperative course, survival, and functional outcomes, and to identify additional factors influencing the long-term survival and disease recurrence in patients receiving salvage laryngectomy. Method: Retrospective chart review of patients with recurrent squamous cell carcinoma (SCC) of the larynx receiving salvage laryngectomy at Cleveland Clinic from 1997 to 2011. Disease-specific survival (DSS), overall survival (OS), functional outcomes, recurrence rate, and postoperative course were evaluated against the methods of primary site and neck treatment. Results: The series is composed of 109 patients. The 5-year DSS and 5-year OS rates were 70.2% and 62.9%, respectively. Laryngeal preservation rate after PL was 80%, with 34% overall complication rate for all patients. No significant differences were noted in 5-year OS ( P = .3241), postsalvage recurrence rate ( P = .3374), postoperative course, or functional outcomes between salvage TL and PL. Five-year DSS was higher in the PL group ( P = .0309). Primary tumor location, presalvage treatment, initial/recurrent T-staging, and neck dissection were not significant predictors of survival or recurrence ( P = NS), but positive nodal disease ( P = .0320), rN-staging ( P = .0474), and postsalvage recurrence ( P < .0001) were predictors of worse prognosis. Conclusion: Salvage PL and TL are both effective procedures in treatment of recurrent laryngeal cancer after treatment failure, with similar efficacy in disease control, survival, functional outcomes, and complication rate in highly selected patients.