Can You Swallow after Salvage Laryngectomy? A 3-Year Study of Swallowing Outcomes following Salvage Total Laryngectomy in South-Western Sydney
Authors List
Li, W., Jones, K., Vasan, K., Latis, S., McGuiness, A J., Liverpool Hospital, NSW, Australia
Introduction
Salvage total laryngectomy (STL) following chemoradiotherapy is associated with poor wound outcomes which are thought to impair swallowing. Long-term post-operative swallowing function and rehabilitation is of great interest to laryngectomees, clinicians and speech pathologists and warrants detailed assessment.
Aims
To assess 3-year postoperative swallowing outcomes in STL patients.
Methods
A retrospective cohort analysis was performed on consecutive adults with recurrent laryngeal cancer treated with STL with or without pharyngectomy. Population, disease and surgical characteristics were collected. Functional oral intake scale (FOIS) scores and feeding tube dependency rates were collected prior to surgery and post-operatively at 6 months, 1, 2 and 3 years. Pharyngocutaneous fistula (PCF), time to PCF, pharyngeal dilatation, and the time to first dilatation were also assessed. Outcomes were compared based on laryngectomy type (total, total with partial pharyngectomy, total laryngopharyngectomy).
Results
34 patients (age 64.7±9.5 years, 82.4% male, 91.2% smokers) underwent salvage laryngectomy. Primary closure with or without on-lay flap was used in 47.1% and free tissue transfer was used in 51.4%. Median FOIS was significantly higher at 1 year (6) compared to pre-operative FOIS (4.5), Z=238.5, p=0.0039 but similar at another follow-up. Rate of feeding tube dependence was 42.4% pre-operatively and 10% at 3 years. PCF developed in 32.4% with mean time to PCF of 44±46.8 days, 32.4% required pharyngeal dilatation with mean time to dilatation of 9.8±9.0 months. At 1-year, total laryngopharyngectomy patients had significantly lower median FOIS compared to total laryngectomy with or without partial pharyngectomy 2(2) = 12.57, p=.002 and higher rates of feeding tube dependence 75% v 0% v 9.5%, p=0.027. Free-flap reconstruction was associated with worse FOIS at 1-year.
Conclusion
STL patients can maintain good swallowing function in the 3-year post-operative period. At 1-year after surgery, TLP and free-flap reconstruction were associated worse swallow.
Li, W., Jones, K., Vasan, K., Latis, S., McGuiness, A J., Liverpool Hospital, NSW, Australia
Introduction
Salvage total laryngectomy (STL) following chemoradiotherapy is associated with poor wound outcomes which are thought to impair swallowing. Long-term post-operative swallowing function and rehabilitation is of great interest to laryngectomees, clinicians and speech pathologists and warrants detailed assessment.
Aims
To assess 3-year postoperative swallowing outcomes in STL patients.
Methods
A retrospective cohort analysis was performed on consecutive adults with recurrent laryngeal cancer treated with STL with or without pharyngectomy. Population, disease and surgical characteristics were collected. Functional oral intake scale (FOIS) scores and feeding tube dependency rates were collected prior to surgery and post-operatively at 6 months, 1, 2 and 3 years. Pharyngocutaneous fistula (PCF), time to PCF, pharyngeal dilatation, and the time to first dilatation were also assessed. Outcomes were compared based on laryngectomy type (total, total with partial pharyngectomy, total laryngopharyngectomy).
Results
34 patients (age 64.7±9.5 years, 82.4% male, 91.2% smokers) underwent salvage laryngectomy. Primary closure with or without on-lay flap was used in 47.1% and free tissue transfer was used in 51.4%. Median FOIS was significantly higher at 1 year (6) compared to pre-operative FOIS (4.5), Z=238.5, p=0.0039 but similar at another follow-up. Rate of feeding tube dependence was 42.4% pre-operatively and 10% at 3 years. PCF developed in 32.4% with mean time to PCF of 44±46.8 days, 32.4% required pharyngeal dilatation with mean time to dilatation of 9.8±9.0 months. At 1-year, total laryngopharyngectomy patients had significantly lower median FOIS compared to total laryngectomy with or without partial pharyngectomy 2(2) = 12.57, p=.002 and higher rates of feeding tube dependence 75% v 0% v 9.5%, p=0.027. Free-flap reconstruction was associated with worse FOIS at 1-year.
Conclusion
STL patients can maintain good swallowing function in the 3-year post-operative period. At 1-year after surgery, TLP and free-flap reconstruction were associated worse swallow.
