title: Quality-of-life and functional outcomes following pharyngolaryngectomy: a systematic review of literature.
abstract: BACKGROUND
  The long-term prognosis of hypopharyngeal cancer is poor. Surgery necessitates pharyngolaryngectomy with flap reconstruction. For such patients, it is important that functional outcomes are preserved to maintain a respectable quality of life.
  
  
  OBJECTIVE
  To identify the functional outcomes following pharyngolaryngectomy with respect to quality of life, speech and swallow through a systematic review of literature.
  
  
  METHODS
  Searches of EBM databases and literature databases using key words: pharyngolaryngectomy, laryngopharyngectomy, swallow, dysphagia, speech and dysphonia from 1970 to August 2014. Articles were screened for relevance using pre-determined inclusion and exclusion criteria.
  
  
  METHODS
  Articles reviewed by authors and data compiled in tables for analysis.
  
  
  RESULTS
  No previous systematic reviews assessing functional outcomes were identified. Seventeen studies reported speech outcomes (576 patients) and fifteen reported swallow outcomes (1076 patients). The data suggests that patients who underwent trachea-oesophageal puncture developed more favourable speech outcomes than those rehabilitated using other measures. Overall stricture incidence was 11.4% and 6.5% of patients required long-term enteral nutrition. Four studies used validated speech measures, and three used validated swallow measures. They suggest an overall level of perceived impairment in quality of life. Speech and swallow outcomes were significantly poorer than patients who underwent total laryngectomy.
  
  
  CONCLUSIONS
  Overall, there is an impairment in speech and swallow outcomes following pharyngolaryngectomy; however, the exact extent is unclear. There is a need for a general consensus on assessment measures and prospective multicentre studies to be conducted. This study compiles the available data to improve caregiver and patient awareness of functional outcomes.
authors.affiliation: University of Edinburgh, Edinburgh, UK.|Department of Otolaryngology, Head and Neck Surgery, East Surrey Hospital, Redhill, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mahalingam
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, East Surrey Hospital, Redhill, UK.
authors.forename: R
authors.initials: R
authors.lastname: Srinivasan
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, East Surrey Hospital, Redhill, UK.|Department of Otolaryngology, Head and Neck Surgery, Ninewells Hospital, University Department of Otolaryngology, Dundee, UK.
authors.forename: P
authors.initials: P
authors.lastname: Spielmann
mesh_terms: D003679:Deglutition / Q000502:physiology; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D007825:Laryngectomy; D010611:Pharyngectomy; D011788:Quality of Life; D013060:Speech / Q000502:physiology; D016896:Treatment Outcome