title: Outcomes of elective total laryngectomy for laryngopharyngeal dysfunction in disease-free head and neck cancer survivors.
abstract: OBJECTIVE
  Total laryngectomy (TL) can be offered for management of chronic aspiration, radionecrosis, and/or airway compromise after head and neck cancer (HNC) treatment. The objective of this study was to evaluate functional outcomes after TL in disease-free HNC survivors.
  
  
  METHODS
  Retrospective case series with chart review.
  
  
  METHODS
  The University of Texas MD Anderson Cancer Center.
  
  
  METHODS
  Twenty-three disease-free HNC survivors who underwent TL for laryngopharyngeal dysfunction.
  
  
  METHODS
  TL ± pharyngectomy.
  
  
  METHODS
  Post-TL swallowing-related (diet, gastrostomy dependence, and pneumonia rates) and communication outcomes.
  
  
  RESULTS
  All patients who underwent TL for dysfunction were previously treated with radiotherapy (12/23, 52%) or chemoradiotherapy (11/23, 48%). Preoperative complications included aspiration (22/23, 96%), pneumonia (16/23, 70%), tracheostomy (9/23, 39%), and stricture (7/23, 30%); 17 patients (74%) required enteral/parenteral nutrition, and 13 of 23 (57%) were nothing per oral (NPO). Rates of pneumonia, NPO status, and feeding tube dependence significantly decreased after TL (P < .001). At last follow-up after TL, all patients tolerated oral intake, but 4 (17%) required supplemental enteral nutrition. Continued smoking after radiotherapy and a preoperative history of recurrent pneumonia were significantly (P < .05) associated with final tube dependence and/or diet level. Sixteen patients (70%) underwent tracheoesophageal (TE) puncture, and 57% (13 of 23) communicated using TE voice after TL.
  
  
  CONCLUSIONS
  Salvage TL may improve health status by significantly decreasing the rate of pneumonia and improve quality of life by restoring oral intake in patients with refractory laryngopharyngeal dysfunction after HNC treatment. TE voice restoration may enhance functional outcomes in select patients treated with elective TL for dysfunction.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. karnold@mdanderson.org
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hutcheson
authors.forename: Clare P
authors.initials: CP
authors.lastname: Alvarez
authors.forename: Denise A
authors.initials: DA
authors.lastname: Barringer
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kupferman
authors.forename: Peter R
authors.initials: PR
authors.lastname: Lapine
authors.forename: Jan S
authors.initials: JS
authors.lastname: Lewin
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D007818:Laryngeal Diseases / Q000209:etiology* / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D017741:Survivors; D016896:Treatment Outcome