title: Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10-year retrospective longitudinal study in Eastern Denmark.
abstract: OBJECTIVE
  To determine the rates of and risk factors for postoperative complications following total laryngectomy in patients treated with radiotherapy or chemoradiation.
  
  
  METHODS
  Retrospective longitudinal study.
  
  
  METHODS
  Tertiary medical centres.
  
  
  METHODS
  A total of 143 patients undergoing total laryngectomy for squamous cell carcinoma of the larynx or hypopharynx.
  
  
  METHODS
  Overall postoperative complications and fistula formation.
  
  
  RESULTS
  Overall postoperative complications, fistula formation, wound infection, bleeding and wound necrosis within one year after total laryngectomy occurred in 56.6%, 42.3%, 31.0%, 11.3% and 9.2% of patients, respectively. Stenosis of the pharynx/oesophagus and stoma shrinkage within five years after surgery were each seen in 18.2% of cases. In 66.7% of cases, conservative treatment of the fistulas was chosen. Rehospitalisations within five years occurred for 44.8% with a median rate of 1.5 (range 1-11). Smoking status (P = 0.005 and 0.013) and chronic obstructive pulmonary disease (COPD) (P = 0.013 and 0.011) were significant risk factors for both overall postoperative complications and fistula formation in uni- and multivariate analysis. Tumour localisation in the hypopharynx was associated with overall postoperative complications (P = 0.036). Residual tumour or cancer recurrence was associated with late-onset fistulas (P < 0.001).
  
  
  CONCLUSIONS
  The frequencies of postoperative complications after total laryngectomy were comparable with similar international studies, although fistula formation rate is increasing in Denmark. We suggest optimising treatment of COPD and to further encourage to smoking cessation. We propose that development of fistulas >2 months after surgery prompts immediate biopsies. Additionally, we suggest standardised registration of surgical techniques to identify variables affecting the frequency of postoperative complications.
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark.
authors.forename: N B
authors.initials: NB
authors.lastname: Wulff
authors.affiliation: Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Denmark.
authors.forename: C A
authors.initials: CA
authors.lastname: Kristensen
authors.affiliation: Department of Oncology, Herlev Hospital, University Hospital of Copenhagen, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Andersen
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Charabi
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark.
authors.forename: C H
authors.initials: CH
authors.lastname: Sørensen
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark.|Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Homøe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000628:therapy*; D059248:Chemoradiotherapy; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000628:therapy*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends