Defining the low-risk salvage laryngectomy-A single-center retrospective analysis of pharyngocutaneous fistula.

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Defining the low-risk salvage laryngectomy-A single-center retrospective analysis of pharyngocutaneous fistula.

Laryngoscope Investig Otolaryngol. 2018 Apr;3(2):115-120

Authors: Vasani SS, Youssef D, Lin C, Wellham A, Hodge R

Abstract
Objectives: Salvage total laryngectomies (STL) are not a homogeneous group. Most will fall into two groups: i) Patients with previous AJCC stage I/II larynx cancer who have had radiotherapy to the larynx only (STL-LOR), or ii) Patients who have had previous AJCC stage III/IV larynx cancer and subsequent radiotherapy to the larynx and draining nodal basins with concurrent cisplatin chemotherapy (STL-CRT). We aimed to compare PCF rates following STL in these two groups.
Methods: A retrospective review of the department's cohort between January 2010 and August 2015 was conducted.
Results: Seventy-seven patients underwent total laryngectomy for larynx cancer between January 2010 and August 2015. There were 10 post-laryngectomy fistulas (13.0%). Three of these occurred in the 38 patients undergoing primary total laryngectomy (PTL), and seven in the 39 patients undergoing STL, rates of 7.9% and 17.9%, respectively. Twenty-two patients had received radiation to the larynx alone without chemotherapy (STL-LOR) for initial Stage I/II disease. Eleven patients had received laryngeal and neck irradiation plus cisplatin chemotherapy (STL-CRT) for initial stage III/IV disease. Of the 22 STL-LOR patients, two developed PCF (9.1%). Of the 11 STL-CRT patients, five developed PCF. There was no difference in the rate of PCF between PTL and STL-LOR. There was a statistically significant increase in PCF in STL-CRT versus PTL (p = .009) and in PCF in STL-CRT versus STL-LOR (p = .027).
Conclusion: Salvage laryngectomies are often treated as a homogenous group. We demonstrate that PCF rates vary significantly depending on preoperative radiation fields and the use of chemotherapy.
Level of Evidence: 2b.

PMID: 29721544 [PubMed]

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