Abstract
ObjectiveIn total laryngectomy, the neopharynx can be closed in several ways. It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with “T”-shaped closure, causing postoperative dysphagia. We report the results of patients treated with vertical closure and “T”-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia.MethodsIn our retrospective cohort study, we identified 117 consecutive laryngectomized patients treated in the VU University Medical Center of Amsterdam between March 2009 and December 2013. Evaluations with statistical analysis of postoperative outcome measures (the formation of a pseudo-diverticulum and dysphagia), qualitative and quantitative variables were conducted.ResultsPatient demographics were similar between the vertical-shaped closure and the “T”-shaped closure groups. In 84.6% of patients with vertical closure, a pseudo-diverticulum was seen compared to 18.5% with “T”-shaped closure (p < 0.001). Dysphagia was increasingly seen in patients with a pseudo-diverticulum (60.5%) compared to patients without a pseudo-diverticulum (39.5%) (p = 0.090).ConclusionFormation of a pseudo-diverticulum is more frequently seen in laryngectomy patients closed with vertical closure than in patients closed with “T”-shaped closure of the neopharynx. It is favorable to implement “T”-shaped closure in laryngectomy.
Highlights
One of the treatment options in advanced stage laryngeal and hypopharyngeal cancer is laryngectomy
It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with ‘‘T’’-shaped closure, causing postoperative dysphagia
We report the results of patients treated with vertical closure and ‘‘T’’-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia
Summary
One of the treatment options in advanced stage laryngeal and hypopharyngeal cancer is laryngectomy. The reported incidence of postoperative dysphagia varies from 17 to 72% [1, 5, 6] This symptom has several causes, such as tumour recurrence, pharyngeal dysmotility, stricture formation, pharyngocutaneous fistulas, and postoperative radiotherapy and the formation of a pseudo-diverticulum [7,8,9]. The kind of dysphagia that it can cause can be obstructive, the feeling of having to ‘‘swallow over a hump’’ or with a typical regurgitative character similar to the dysphagia found in patients with a Zenker’s diverticulum [10] History of these symptoms combined with physical examination and/or barium swallow radiograph leads to the diagnosis of the pseudodiverticulum
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