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Outcomes of elective total laryngectomy for laryngopharyngeal dysfunction in disease-free head and neck cancer survivors.
- Source :
-
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2012 Apr; Vol. 146 (4), pp. 585-90. Date of Electronic Publication: 2012 Jan 10. - Publication Year :
- 2012
-
Abstract
- Objective: Total laryngectomy (TL) can be offered for management of chronic aspiration, radionecrosis, and/or airway compromise after head and neck cancer (HNC) treatment. The objective of this study was to evaluate functional outcomes after TL in disease-free HNC survivors.<br />Design: Retrospective case series with chart review.<br />Setting: The University of Texas MD Anderson Cancer Center.<br />Patients: Twenty-three disease-free HNC survivors who underwent TL for laryngopharyngeal dysfunction.<br />Intervention: TL ± pharyngectomy.<br />Main Outcome Measures: Post-TL swallowing-related (diet, gastrostomy dependence, and pneumonia rates) and communication outcomes.<br />Results: All patients who underwent TL for dysfunction were previously treated with radiotherapy (12/23, 52%) or chemoradiotherapy (11/23, 48%). Preoperative complications included aspiration (22/23, 96%), pneumonia (16/23, 70%), tracheostomy (9/23, 39%), and stricture (7/23, 30%); 17 patients (74%) required enteral/parenteral nutrition, and 13 of 23 (57%) were nothing per oral (NPO). Rates of pneumonia, NPO status, and feeding tube dependence significantly decreased after TL (P < .001). At last follow-up after TL, all patients tolerated oral intake, but 4 (17%) required supplemental enteral nutrition. Continued smoking after radiotherapy and a preoperative history of recurrent pneumonia were significantly (P < .05) associated with final tube dependence and/or diet level. Sixteen patients (70%) underwent tracheoesophageal (TE) puncture, and 57% (13 of 23) communicated using TE voice after TL.<br />Conclusion: Salvage TL may improve health status by significantly decreasing the rate of pneumonia and improve quality of life by restoring oral intake in patients with refractory laryngopharyngeal dysfunction after HNC treatment. TE voice restoration may enhance functional outcomes in select patients treated with elective TL for dysfunction.
- Subjects :
- Adult
Aged
Chi-Square Distribution
Elective Surgical Procedures
Female
Head and Neck Neoplasms therapy
Humans
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Survivors
Treatment Outcome
Head and Neck Neoplasms complications
Laryngeal Diseases etiology
Laryngeal Diseases surgery
Laryngectomy
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6817
- Volume :
- 146
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 22235071
- Full Text :
- https://doi.org/10.1177/0194599811432264