title: Functional results of pharyngo-laryngectomy and total laryngectomy: a comparison.
abstract: OBJECTIVE
  To compare the key functional results (regarding swallowing and voice rehabilitation) in patients treated by pharyngo-laryngectomy with flap reconstruction, versus standard, wide-field, total laryngectomy.
  
  
  METHODS
  We studied 97 patients who had undergone total laryngectomy and pharyngo-laryngectomy with flap reconstruction. The main outcome measures were swallowing (i.e. solid food, soft diet, fluid or enteral feeding) and fluent voice development.
  
  
  RESULTS
  There were 79 men and 18 women, with follow up of one to 19 years. Voice (p = 0.037) and swallowing (p = 0.041) results were significantly worse after circumferential pharyngo-laryngectomy than after non-circumferential pharyngo-laryngectomy. There was no significant difference in voice (p = 0.23) or swallowing (p = 0.655) results, comparing total laryngectomy and non-circumferential pharyngo-laryngectomy. The presence of a post-operative fistula significantly influenced voice (p = 0.001) and swallowing (p = 0.009) outcomes.
  
  
  CONCLUSIONS
  The additional measures involved in pharyngo-laryngectomy do not confer any functional disadvantage, compared with total laryngectomy, but only if the procedure is non-circumferential. Functional results of circumferential pharyngo-laryngectomy are worse than those of both non-circumferential pharyngo-laryngectomy and total laryngectomy. If oncologically possible and safe, it is better to keep a pharyngo-laryngectomy non-circumferential.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Manchester Academic Health Science Centre, Manchester Royal Infirmary, University of Manchester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Gadepalli
authors.forename: C
authors.initials: C
authors.lastname: de Casso
authors.forename: S
authors.initials: S
authors.lastname: Silva
authors.forename: S
authors.initials: S
authors.lastname: Loughran
authors.forename: J J
authors.initials: JJ
authors.lastname: Homer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000503:physiopathology / Q000601:surgery*; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005402:Fistula / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000503:physiopathology / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010611:Pharyngectomy / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D012189:Retrospective Studies; D013065:Speech Intelligibility / Q000502:physiology; D013524:Surgical Flaps; D016896:Treatment Outcome; D014832:Voice Disorders / Q000209:etiology / Q000534:rehabilitation; D014833:Voice Quality