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Twenty-year experience with salvage total laryngectomy: lessons learned

Published online by Cambridge University Press:  05 July 2021

N Tsetsos ,
A Poutoglidis ,
K Vlachtsis ,
M Stavrakas ,
A Nikolaou  and
G Fyrmpas
N Tsetsos*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, ‘G. Papanikolaou’ General Hospital, Thessaloniki, Greece
A Poutoglidis
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, ‘G. Papanikolaou’ General Hospital, Thessaloniki, Greece
K Vlachtsis
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, ‘G. Papanikolaou’ General Hospital, Thessaloniki, Greece
M Stavrakas
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Derriford Hospital University Hospitals Plymouth NHS Trust, Plymouth, UK
A Nikolaou
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, ‘G. Papanikolaou’ General Hospital, Thessaloniki, Greece
G Fyrmpas
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, ‘G. Papanikolaou’ General Hospital, Thessaloniki, Greece
*
Author for correspondence: Dr Nikolaos Tsetsos, Department of Otorhinolaryngology – Head and Neck Surgery, ‘G. Papanikolaou’ General Hospital, Exochi, Thessaloniki57010, Greece E-mail: [email protected]
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Abstract

Objective

The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement.

Method

A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed.

Results

Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1–T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent.

Conclusion

More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

Keywords

Laryngeal NeoplasmsLaryngectomyRadiotherapyChemoradiotherapyNeck Dissection
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 8 , August 2021 , pp. 729 - 736
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr N Tsetsos takes responsibility for the integrity of the content of the paper

References

Cancer stat facts: laryngeal cancer. In: https://seer.cancer.gov/statfacts/html/laryn.html [13 August 2020]Google Scholar
Silverman, DA, Puram, SV, Rocco, JW, Old, MO, Kang, SY. Salvage laryngectomy following organ-preservation therapy - an evidence-based review. Oral Oncol 2019;88:137–44CrossRefGoogle ScholarPubMed
Wulff, NB, Andersen, E, Kristensen, CA, Sørensen, CH, Charabi, B, Homøe, P. Prognostic factors for survival after salvage total laryngectomy following radiotherapy or chemoradiation failure: a 10-year retrospective longitudinal study in eastern Denmark. Clin Otolaryngol 2017;42:336–46CrossRefGoogle ScholarPubMed
Mimica, X, Hanson, M, Patel, SG, McGill, M, McBride, S, Lee, N et al. Salvage surgery for recurrent larynx cancer. Head Neck 2019;41:3906–15CrossRefGoogle ScholarPubMed
Basheeth, N, O'Leary, G, Sheahan, P. Elective neck dissection for no neck during salvage total laryngectomy: findings, complications, and oncological outcome. JAMA Otolaryngol Head Neck Surg 2013;139:790–6CrossRefGoogle ScholarPubMed
Sandulache, VC, Vandelaar, LJ, Skinner, HD, Cata, J, Hutcheson, K, Fuller, CD et al. Salvage total laryngectomy after external-beam radiotherapy: a 20-year experience. Head Neck 2016;38(suppl 1):e1962–8CrossRefGoogle ScholarPubMed
Scharpf, J, Ward, M, Adelstein, D, Koyfman, S, Li, M. Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation. Laryngoscope 2018;128:823–30CrossRefGoogle ScholarPubMed
Adeel, M, Faisal, M, Rashid, A, Rasheed, S, Hussain, R, Malik, KI et al. Outcomes of definitive radiotherapy for early laryngeal cancer in terms of survival and patterns of failure. J Laryngol Otol 2019;133:1087–91CrossRefGoogle ScholarPubMed
Mourad, WF, Hu, KS, Shourbaji, RA, Woode, R, Harrison, LB. Long-term follow-up and pattern of failure for T1-T2 glottic cancer after definitive radiation therapy. Am J Clin Oncol 2013;36:580–3CrossRefGoogle ScholarPubMed
Baugnon, KL, Beitler, JJ. Pitfalls in the staging of cancer of the laryngeal squamous cell carcinoma. Neuroimaging Clin N Am 2013;23:81–105CrossRefGoogle ScholarPubMed
Browman, GP, Wong, G, Hodson, I, Sathya, J, Russell, R, McAlpine, L et al. Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 1993;328:159–63CrossRefGoogle ScholarPubMed
Ganly, I, Patel, SG, Matsuo, J, Singh, B, Kraus, DH, Boyle, JO et al. Results of surgical salvage after failure of definitive radiation therapy for early-stage squamous cell carcinoma of the glottic larynx. Arch Otolaryngol Head Neck Surg 2006;132:59–66CrossRefGoogle ScholarPubMed
Deganello, A, Meccariello, G, Bini, B, Paiar, F, Santoro, R, Mannelli, G et al. Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer? J Laryngol Otol 2014;128:1089–94CrossRefGoogle ScholarPubMed
Birkeland, AC, Beesley, L, Bellile, E, Rosko, AJ, Hoesli, R, Chinn, SB et al. Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma. Head Neck 2017;39:2512–18CrossRefGoogle ScholarPubMed
Farlow, JL, Birkeland, AC, Rosko, AJ, VanKoevering, K, Haring, CT, Smith, JD et al. Elective paratracheal lymph node dissection in salvage laryngectomy. Ann Surg Oncol 2019;26:2542–8CrossRefGoogle ScholarPubMed
Stoeckli, SJ, Pawlik, AB, Lipp, M, Huber, A, Schmid, S. Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx. Arch Otolaryngol Head Neck Surg 2000;126:1473–7CrossRefGoogle ScholarPubMed
Meulemans, J, Debacker, J, Demarsin, H, Vanclooster, C, Neyt, P, Mennes, T et al. Oncologic outcomes after salvage laryngectomy for squamous cell carcinoma of the larynx and hypopharynx: a multicenter retrospective cohort study. Ann Surg Oncol 2020;28:1751–61CrossRefGoogle ScholarPubMed
Hay, A, Simo, R, Hall, G, Tharavai, S, Oakley, R, Fry, A et al. Outcomes of salvage surgery for the oropharynx and larynx: a contemporary experience in a UK cancer centre. Eur Arch Otorhinolaryngol 2019;276:1153–9CrossRefGoogle Scholar
Gross, JH, Vila, PM, Simon, L, Rizvi, ZH, Zenga, J, Jackson, RS et al. Elective neck dissection during salvage laryngectomy: a systematic review and meta-analysis. Laryngoscope 2020;130:899–906CrossRefGoogle ScholarPubMed
Lin, DJ, Lam, A, Warner, L, Paleri, V. Elective neck dissection in patients with radio-recurrent and radio-residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: systematic review and meta-analysis. Head Neck 2019;41:4026–35CrossRefGoogle ScholarPubMed
Bohannon, IA, Desmond, RA, Clemons, L, Magnuson, JS, Carroll, WR, Rosenthal, EL. Management of the N0 neck in recurrent laryngeal squamous cell carcinoma. Laryngoscope 2010;120:58–61Google ScholarPubMed
Hilly, O, Stern, S, Horowitz, E, Leshno, M, Feinmesser, R. Is there a role for elective neck dissection with salvage laryngectomy? A decision-analysis model. Laryngoscope 2013;123:2706–11CrossRefGoogle Scholar
Yuen, AP, Wei, WI, Ho, CM. Results of surgical salvage for radiation failures of laryngeal carcinoma. Otolaryngol Head Neck Surg 1995;112:405–9CrossRefGoogle ScholarPubMed
Burge, JS. Histological changes in cervical lymph nodes following clinical irradiation. Proc R Soc Med 1975;68:77–9Google ScholarPubMed
Rosko, A, Birkeland, A, Shuman, A, Prince, M, Bradford, C, Wolf, G et al. Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer. Head Neck 2017;39:980–7CrossRefGoogle ScholarPubMed
Hasan, Z, Dwivedi, RC, Gunaratne, DA, Virk, SA, Palme, CE, Riffat, F. Systematic review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg Oncol 2017;43:42–51CrossRefGoogle ScholarPubMed
Kim, YH, Roh, JL, Choi, SH, Nam, SY, Kim, SY. Prediction of pharyngocutaneous fistula and survival after salvage laryngectomy for laryngohypopharyngeal carcinoma. Head Neck 2019;41:3002–8CrossRefGoogle ScholarPubMed
Microvascular Committee of the American Academy of Otolaryngology-Head & Neck Surgery. Salvage laryngectomy and laryngopharyngectomy: multicenter review of outcomes associated with a reconstructive approach. Head Neck 2019;41:16–29CrossRefGoogle Scholar
Sittitrai, P, Srivanitchapoom, C, Reunmakkaew, D. Prevention of pharyngocutaneous fistula in salvage total laryngectomy: role of the pectoralis major flap and peri-operative management. J Laryngol Otol 2018;132:246–51CrossRefGoogle ScholarPubMed