Stoma Recurrence after Laryngectomy: An Analysis of Risk Factors

Abstract

Data from 130 patients who underwent total laryngectomy for squamous cell carcinoma of the larynx were reviewed. Patients were treated either by primary laryngectomy and planned postoperative radiotherapy or by primary radiotherapy and subsequent salvage laryngectomy. Patients with other treatment modalities and patients with positive margins of resection and laryngectomies for hypopharyngeal cancers were excluded from the study. The stomal recurrence rate with reference to several risk factors, such as primary tumor stage, location of tumor, lymph node metastases, timing of tracheotomy, and presence of a postoperative pharyngoperistomal fistula, was analyzed. The overall incidence of stomal recurrence was 10%. The treatment modality appeared to have an impact on subsequent stomal recurrence: stomal recurrence developed more often after salvage laryngectomy (18.4%) than after primary laryngectomy with planned postoperative radiation (4.8%). Advanced T stage, N stage, subglottic involvement, and preoperative tracheotomy are risk factors for stomal recurrence only in patients with a primary laryngectomy. Stomal recurrence developed in only four patients after primary laryngectomy with planned radiation. All four patients had more than one risk factor: primary tumor stage T4 (four times), subglottic involvement (three times), and preoperative tracheotomy (three times). The presence of a postoperative pharyngoperistomal fistula likewise may represent a risk factor for the development of a stomal recurrence.