Clinical Outcome After Total Laryngectomy in Laryngeal and Hypopharyngeal Carcinoma
Keywords:
Total laryngecomy; Laryngeal cancer; Hypopharyngeal cancer; Pharyngocutaneous fistulaAbstract
Background and objective: Total laryngectomy has the major role in laryngeal and hypopharyngeal cancer treatment. The most common post-operative complication was pharyngocutaneous fistula particularly the patients who undergoing total laryngectomy after previous radiotherapy. This study aimed to evaluate the incidence of pharyngocutaneous fistula and also the overall survival after surgery.
Method: This is the retrospective study of patients who underwent total laryngectomy or total laryngopharyngectomy between 2014 and 2018 at National Cancer Institute, Thailand.
Results: Forty-two male patients were included in the study. The primary total laryngectomy accounted for 66.7% of the laryngectomy procedures. Moreover, there was no patient experienced post-operative pharyngocutaneous fistula. In the follow-up period, there were 11 patients (26.2%) had recurrent disease.The most common pattern of recurrent was lung metastasis.The patients who underwent primary surgery had 3-year DFS, 5-years DFS, 3-year OS and 5-year OS as 79.4%, 79.4%, 77.3% and 65.6%, respectively. While the salvage surgery group had lesser surival outcome. This group had 3-year DFS , 5-years DFS , 3-year OS and 5-year OS about 46.5% , 42.3% , 62.6% and 59.7% ,respectively. Nonetheless,there was statistically significant in DFS ( log rank test, p< 0.05) between both groups but not in OS ( log rank test, p=0.66). Perineural invasion and extranodal extension were the significant negative impact factor in DFS.
Conclusion: Selecting the patients for appropriate surgical candidates together with repairing the neopharynx with zipper technique or PMM flap resulted no pharyngocutaneous fistula incidence in this study. Moreover, the post-operative radiotherapy or post-operative chemoradiation after surgery encouraged the survival outcome in primary surgery group in this study.
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