title: Oncologic outcomes of total laryngectomy: impact of margins and preoperative tracheostomy.
abstract: BACKGROUND
  The purpose of this present study was to investigate risk factors for local recurrence and death after total laryngectomy, with particular emphasis on pattern of local recurrence (stomal vs pharyngeal/base of tongue) and impact of preceding tracheostomy.
  
  
  METHODS
  We conducted a retrospective review of 75 consecutive total laryngectomies for cancer of the larynx.
  
  
  RESULTS
  Nineteen patients underwent preoperative tracheostomy, which was a significant risk factor for local recurrence (p = .04). With regard to pattern of local recurrence, preoperative tracheostomy (p = .03) and pathological nodal status (pN+; p = .04) were significant for stomal, but not pharyngeal recurrence; whereas positive margins (p = .01) was significant for pharyngeal, but not stomal recurrence. Preoperative tracheostomy, pN+, lymphovascular invasion, and positive margins were all significant for survival.
  
  
  CONCLUSIONS
  Preoperative tracheostomy continues to be a significant adverse prognosticator in patients undergoing total laryngectomy. Our findings also suggest distinct causative factors for different patterns of postlaryngectomy local recurrence.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Naveed
authors.initials: N
authors.lastname: Basheeth
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Leary
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Habib
authors.initials: H
authors.lastname: Khan
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007494:Ireland; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
keywords: carcinoma; laryngectomy; larynx; local neoplasm recurrence; squamous cell; tracheostomy