Total laryngectomy for a dysfunctional larynx after (chemo)radiotherapy.
OBJECTIVE
To evaluate the functional outcomes after total laryngectomy (TLE) for a dysfunctional larynx in patients with head and neck cancer that is in complete remission after (chemo)radiotherapy.


METHODS
Retrospective cohort study.


METHODS
Tertiary comprehensive cancer center.


METHODS
The study included 25 patients from a cohort of 217 consecutive patients with TLE who were treated between January 2000 and July 2010. The inclusion criteria for this subgroup analysis were complete remission and functional problems for which TLE was considered to be the only resolution. Quality of life assessment was carried out using the European Organization for Research and Treatment of Cancer Quality of Life C30 and Head and Neck Module 35 questionnaires and an additional study-specific questionnaire covering functional aspects, such as swallowing and dyspnea, in more detail.


METHODS
Total laryngectomy.


METHODS
Morbidity, mortality, and functional outcomes. RESULTS The indication for TLE was chronic aspiration with or without recurrent pneumonia (n = 15 [60%]), debilitating dyspnea (n = 8 [32%]), and persistent profuse hemorrhage (radiation ulcer) (n = 2 [8%]). After TLE, 14 of the 25 patients (56%) had 20 major postoperative complications, including 11 pharyngocutaneous fistulas, requiring additional treatment. Tube feeding and recurrent pneumonia incidence had decreased from 80% and 28% to 29% and 0%, respectively, 2 years after surgery. Prosthetic voice rehabilitation was possible in 19 patients (76%). Two years after surgery, 10 of 14 patients (71%) still reported TLE-related pulmonary problems despite the consistent use of a heat and moisture exchanger. The 5-year overall survival rate was 35%.


CONCLUSIONS
Total laryngectomy for a dysfunctional larynx tends to have a high complication rate. However, in this study, the initial functional problems (aspiration, recurrent pneumonia, and dyspnea) did not recur. Tube feeding was significantly reduced, and the quality of life of the surviving patients appeared to be reasonable.
Departments of Head and Neck Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
Eleonoor A R
EA
Theunissen
Adriana J
AJ
Timmermans
Charlotte L
CL
Zuur
Olga
O
Hamming-Vrieze
Jan
J
Paul de Boer
Frans J M
FJ
Hilgers
Michiel W M
MW
van den Brekel
D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects*; D017577:Cutaneous Fistula / Q000601:surgery; D005260:Female; D005402:Fistula / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006470:Hemorrhage / Q000601:surgery; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000209:etiology / Q000601:surgery*; D011015:Pneumonia, Aspiration / Q000601:surgery; D011788:Quality of Life; D011832:Radiation Injuries / Q000601:surgery; D012074:Remission Induction / Q000379:methods; D053120:Respiratory Aspiration / Q000601:surgery; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome