Safety and efficacy of functional laryngectomy for end-stage dysphagia.

Abstract

OBJECTIVES/HYPOTHESIS:

To evaluate functional outcomes and complication rate after total laryngectomy (TL) for dysfunctional larynx with end-stage dysphagia.

STUDY DESIGN:

Retrospective chart review.

METHODS:

Chart review was performed on all patients who underwent TL from January 2008 to July 2016 at a single tertiary academic medical center. Patients who underwent TL for dysfunctional larynx without preoperative evidence of malignancy were included. Main outcome measures were post-TL functional swallowing and speech outcomes, and complication rate.

RESULTS:

The study included 19 patients from a cohort of 278 consecutive patients. All patients were previously treated with radiotherapy (RT), whereas 13/19 (68%) previously received chemoradiotherapy. The median time from RT to TL was 10.98 years (range, 0.67-23.94 years). Aspiration was evident preoperatively in 17/19 (89%) patients, with 11 experiencing recurrent aspiration pneumonia. Seventeen of 19 (89%) patients were nil per os (NPO) requiring enteral nutrition. Six of 19 (32%) patients had surgical complications, including three (16%) pharyngocutaneous fistulas. At 3-month and 1-year postoperative follow-up, there was significant improvement in mean Functional Oral Intake Scale (FOIS) score and aspiration, recurrent pneumonia, enteral nutrition, and NPO status rates (P < .05). At 1-year follow-up, no patients were NPO, and only one patient required gastrostomy tube supplementation. Mean FOIS score increased from 1.3 to 6.1 (P = .001). Eight of 13 patients (62%) were actively using a tracheoesophageal prosthesis at 1-year follow-up.

CONCLUSIONS:

Laryngectomy for dysfunctional larynx eliminates the morbidity of aspiration while improving diet and reducing gastrostomy tube dependence with an acceptable complication rate.

LEVEL OF EVIDENCE:

4. Laryngoscope, 128:597-602, 2018.

• Authors: Michael C Topf, Linda C Magaña, Kelly Salmon, James Hamilton, William M Keane, Adam Luginbuhl, Joseph M Curry, David M Cognetti, Maurits Boon, Joseph R Spiegel
• Journal: The Laryngoscope (Laryngoscope) Vol. 128 Issue 3 Pg. 597-602 (03 2018) ISSN: 1531-4995 [Electronic] United States
• PMID: 28714539 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Topics

• Adult
• Aged
• Aged, 80 and over
• Deglutition Disorders (etiology, physiopathology, surgery)
• Female
• Humans
• Laryngeal Neoplasms (complications)
• Laryngectomy (adverse effects, methods)
• Larynx (physiopathology, surgery)
• Male
• Middle Aged
• Postoperative Complications (etiology)
• Respiratory Aspiration (etiology)
• Retrospective Studies
• Treatment Outcome
• Young Adult