Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study
Background/Purpose: We analyzed complications and functional outcomes and aimed at identifying prognostic factors for functional outcomes and complications in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the lary...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.01390/full |
| _version_ | 1818412373979955200 |
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| author | Jeroen Meulemans Jeroen Meulemans Hannelore Demarsin Jens Debacker Gaël Batailde Tillo Mennes Tillo Mennes Annouschka Laenen Ann Goeleven Peter Neyt Christophe Vanclooster Tom Vauterin Pierre Delaere Wouter Huvenne Wouter Huvenne Vincent Vander Poorten Vincent Vander Poorten |
| author_facet | Jeroen Meulemans Jeroen Meulemans Hannelore Demarsin Jens Debacker Gaël Batailde Tillo Mennes Tillo Mennes Annouschka Laenen Ann Goeleven Peter Neyt Christophe Vanclooster Tom Vauterin Pierre Delaere Wouter Huvenne Wouter Huvenne Vincent Vander Poorten Vincent Vander Poorten |
| author_sort | Jeroen Meulemans |
| collection | DOAJ |
| description | Background/Purpose: We analyzed complications and functional outcomes and aimed at identifying prognostic factors for functional outcomes and complications in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx after initial (chemo)radiation.Methods: Retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018. Prognostic factors for functional outcomes and complications were identified with uni- and multivariable analysis.Results: A total of 405 patients were included in the final analysis. STL was performed for residual tumor (40.2%), local recurrence (40.5%), or second primary laryngeal or hypopharyngeal SCC (19.4%). Early postoperative complications were experienced by 34.2% of patients: postoperative hemorrhage occurred in 5.4%, wound infection in 16.2%, and clinical pharyngocutaneous fistula (PCF) in 25.5% of patients. Early readmission proved necessary in 15.1% of cases, most often due to late PCF development (72.2%). Patients achieved total peroral intake in 94.2% of cases. However, subjective dysphagia was reported by 31.3% of patients during follow-up. Functional speech, defined as functional communication by speech without additional aids, was reported in 86.7% of cases and was most often achieved by tracheo-esophageal puncture (TEP) (94.1%). In a multivariable model, lower preoperative hemoglobin (<12.5 g/dl) was identified as an independent prognostic factor for higher overall complication rate. No risk factors were found significant for clinical fistula formation. Vascularized tissue augmentation did not significantly prevent clinical PCF. Patients with positive section margins, patients initially treated with surgery combined with adjuvant RT (vs. radiotherapy alone), and those developing PCF after STL were less likely to achieve total peroral intake. Postoperative dysphagia proved more likely in patients who developed a PCF postoperatively, and less likely in patients who underwent STL without partial pharyngectomy and in patients with myocutaneous pectoralis major (PM) flap reconstruction, compared to muscle onlay PM flap. Achieving postoperative functional speech proved most likely in patients with smaller tumors (lower pT classification) and free section margins.Conclusion: Substantial complication rates and favorable functional outcomes are reported after STL. |
| first_indexed | 2024-12-14T10:46:17Z |
| format | Article |
| id | doaj.art-a7ea32280dd8438492fb7c44f947f117 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-14T10:46:17Z |
| publishDate | 2020-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-a7ea32280dd8438492fb7c44f947f1172022-12-21T23:05:26ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-09-011010.3389/fonc.2020.01390555858Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort StudyJeroen Meulemans0Jeroen Meulemans1Hannelore Demarsin2Jens Debacker3Gaël Batailde4Tillo Mennes5Tillo Mennes6Annouschka Laenen7Ann Goeleven8Peter Neyt9Christophe Vanclooster10Tom Vauterin11Pierre Delaere12Wouter Huvenne13Wouter Huvenne14Vincent Vander Poorten15Vincent Vander Poorten16Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, BelgiumDepartment of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, BelgiumOtorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, BelgiumDepartment of Head and Skin, Ghent University, Ghent, BelgiumOtorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, BelgiumOtorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, BelgiumOtorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, BelgiumInteruniversity Center for Biostatistics and Statistical Bioinformatics, Leuven, BelgiumOtorhinolaryngology-Head and Neck Surgery, Swallowing Clinic, University Hospital Leuven, Leuven, BelgiumOtorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, BelgiumOtorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, BelgiumOtorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Bruges, BelgiumOtorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, BelgiumDepartment of Head and Skin, Ghent University, Ghent, BelgiumOtorhinolaryngology-Head and Neck Surgery, University Hospital Ghent, Ghent, BelgiumOtorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, BelgiumDepartment of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, BelgiumBackground/Purpose: We analyzed complications and functional outcomes and aimed at identifying prognostic factors for functional outcomes and complications in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx after initial (chemo)radiation.Methods: Retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018. Prognostic factors for functional outcomes and complications were identified with uni- and multivariable analysis.Results: A total of 405 patients were included in the final analysis. STL was performed for residual tumor (40.2%), local recurrence (40.5%), or second primary laryngeal or hypopharyngeal SCC (19.4%). Early postoperative complications were experienced by 34.2% of patients: postoperative hemorrhage occurred in 5.4%, wound infection in 16.2%, and clinical pharyngocutaneous fistula (PCF) in 25.5% of patients. Early readmission proved necessary in 15.1% of cases, most often due to late PCF development (72.2%). Patients achieved total peroral intake in 94.2% of cases. However, subjective dysphagia was reported by 31.3% of patients during follow-up. Functional speech, defined as functional communication by speech without additional aids, was reported in 86.7% of cases and was most often achieved by tracheo-esophageal puncture (TEP) (94.1%). In a multivariable model, lower preoperative hemoglobin (<12.5 g/dl) was identified as an independent prognostic factor for higher overall complication rate. No risk factors were found significant for clinical fistula formation. Vascularized tissue augmentation did not significantly prevent clinical PCF. Patients with positive section margins, patients initially treated with surgery combined with adjuvant RT (vs. radiotherapy alone), and those developing PCF after STL were less likely to achieve total peroral intake. Postoperative dysphagia proved more likely in patients who developed a PCF postoperatively, and less likely in patients who underwent STL without partial pharyngectomy and in patients with myocutaneous pectoralis major (PM) flap reconstruction, compared to muscle onlay PM flap. Achieving postoperative functional speech proved most likely in patients with smaller tumors (lower pT classification) and free section margins.Conclusion: Substantial complication rates and favorable functional outcomes are reported after STL.https://www.frontiersin.org/article/10.3389/fonc.2020.01390/fullcomplicationsfunctional outcomeshypopharynxlarynxrecurrencesalvage surgery |
| spellingShingle | Jeroen Meulemans Jeroen Meulemans Hannelore Demarsin Jens Debacker Gaël Batailde Tillo Mennes Tillo Mennes Annouschka Laenen Ann Goeleven Peter Neyt Christophe Vanclooster Tom Vauterin Pierre Delaere Wouter Huvenne Wouter Huvenne Vincent Vander Poorten Vincent Vander Poorten Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study Frontiers in Oncology complications functional outcomes hypopharynx larynx recurrence salvage surgery |
| title | Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study |
| title_full | Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study |
| title_fullStr | Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study |
| title_full_unstemmed | Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study |
| title_short | Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study |
| title_sort | functional outcomes and complications after salvage total laryngectomy for residual recurrent and second primary squamous cell carcinoma of the larynx and hypopharynx a multicenter retrospective cohort study |
| topic | complications functional outcomes hypopharynx larynx recurrence salvage surgery |
| url | https://www.frontiersin.org/article/10.3389/fonc.2020.01390/full |
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