title: Complications of total laryngectomy in the era of chemoradiation.
abstract: As more total laryngectomies (TLE) are nowadays performed as salvage procedures, the rate of postoperative complications increases. The primary aim was to report the rates of postoperative local complications for total laryngectomy in patients with previous radiotherapy or chemoradiotherapy (RT/CRT) in comparison with primary TLE data. We attempted to identify patient- and tumor-related factors predictive of postoperative pharyngocutaneous fistula (PCF) formation. The secondary aims were to analyze the survival rate in relation to postoperative complications and to study prognostic factors of survival in TLE patients. A retrospective study was conducted in 208 patients. Logistic regression was used to determine the most significant risk factors for fistula formation. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox multivariate regression. PCF developed in 20.7% of cases. In the group of patients with previous RT/CRT, the fistula rate was significantly higher (34%). In multivariate analysis, significant risk factors for fistula formation were previous radiotherapy or chemoradiotherapy (p = 0.02), higher N classification (p = 0.03), and procedure performed by a less experienced surgeon (p = 0.003). The survival and recurrence rates were not influenced by PCF formation. The overall survival rates were lower in patients with previous RT/CRT and in patients with lymph node involvement.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Motol University Hospital, V úvalu 84, Praha 5, Prague 15006, Czech Republic. jan.klozar@lfmotol.cuni.cz
authors.forename: Jan
authors.initials: J
authors.lastname: Klozar
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Cada
authors.forename: Eva
authors.initials: E
authors.lastname: Koslabova
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D017577:Cutaneous Fistula / Q000209:etiology*; D005260:Female; D005402:Fistula / Q000209:etiology*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000628:therapy*; D007822:Laryngeal Neoplasms / Q000628:therapy*; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000209:etiology*; D012307:Risk Factors