Predictors of Stricture and Swallowing Function Following Salvage Laryngectomy.
Aged
Carcinoma, Squamous Cell
/ physiopathology
Constriction, Pathologic
/ etiology
Deglutition
Esophageal Fistula
/ etiology
Esophageal Stenosis
/ etiology
Female
Gastrostomy
/ statistics & numerical data
Humans
Hypopharyngeal Neoplasms
/ physiopathology
Hypopharynx
/ surgery
Laryngeal Neoplasms
/ physiopathology
Laryngectomy
/ adverse effects
Larynx
/ surgery
Logistic Models
Male
Middle Aged
Neoplasm Recurrence, Local
/ physiopathology
Odds Ratio
Postoperative Complications
/ etiology
Postoperative Period
Proportional Hazards Models
Retrospective Studies
Salvage Therapy
/ adverse effects
Smoking
/ adverse effects
Time Factors
Treatment Outcome
Head and neck cancer
larynx cancer
quality of life
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
26
09
2020
received:
23
06
2020
accepted:
15
10
2020
pubmed:
6
11
2020
medline:
19
5
2021
entrez:
5
11
2020
Statut:
ppublish
Résumé
Long-term functional outcomes are poorly characterized for salvage laryngectomy. We identified predictors of esophageal stricture and swallowing function after salvage laryngectomy in a large cohort. A retrospective study of 233 patients who underwent salvage total laryngectomy for recurrent/persistent squamous cell carcinoma of the larynx or hypopharynx after radiation (XRT) or chemoradiation (CRT) was performed. Primary outcomes were esophageal dilation within 1 year, time to dilation, and gastrostomy tube dependence. Multivariate logistic and Cox regressions were used for statistical analysis. Dilation was performed in 29.9% of patients. Dilation was twice as likely in patients with post-operative fistula compared to those without (Hazard Ratio (HR) 2.10, 95% Confidence Interval (CI) 1.06-4.13, P = .03). Every year between XRT/CRT and salvage was associated with 10% increase in dilation (HR 1.09, 95% CI 1.03-1.17, P = .01). No factors were associated with dilation by 1 year. About 10% of patients were at least partially gastrostomy tube-dependent 1 year post-operatively. At last follow-up (median 29 months), this rate was 13%. Patients with supraglottic recurrence had an increased risk of gastrostomy tube dependence at 1 year compared to glottic (OR 16.7, 95% CI 1.73-160, P = .02). For every 10 pack years pre-salvage, the OR of requiring tube feeds at last follow-up was 1.24 (95% CI 1.04-1.48, P = .02). Fistula and pre-salvage smoking were associated with stricture post-salvage laryngectomy. No factors were associated with dilation by 1 year. Supraglottic recurrence and smoking were associated with gastrostomy tube dependence. These findings are important for pre-operative counseling prior to salvage laryngectomy. Level 4 Laryngoscope, 131:1229-1234, 2021.
Sections du résumé
BACKGROUND
Long-term functional outcomes are poorly characterized for salvage laryngectomy. We identified predictors of esophageal stricture and swallowing function after salvage laryngectomy in a large cohort.
METHODS
A retrospective study of 233 patients who underwent salvage total laryngectomy for recurrent/persistent squamous cell carcinoma of the larynx or hypopharynx after radiation (XRT) or chemoradiation (CRT) was performed. Primary outcomes were esophageal dilation within 1 year, time to dilation, and gastrostomy tube dependence. Multivariate logistic and Cox regressions were used for statistical analysis.
RESULTS
Dilation was performed in 29.9% of patients. Dilation was twice as likely in patients with post-operative fistula compared to those without (Hazard Ratio (HR) 2.10, 95% Confidence Interval (CI) 1.06-4.13, P = .03). Every year between XRT/CRT and salvage was associated with 10% increase in dilation (HR 1.09, 95% CI 1.03-1.17, P = .01). No factors were associated with dilation by 1 year. About 10% of patients were at least partially gastrostomy tube-dependent 1 year post-operatively. At last follow-up (median 29 months), this rate was 13%. Patients with supraglottic recurrence had an increased risk of gastrostomy tube dependence at 1 year compared to glottic (OR 16.7, 95% CI 1.73-160, P = .02). For every 10 pack years pre-salvage, the OR of requiring tube feeds at last follow-up was 1.24 (95% CI 1.04-1.48, P = .02).
CONCLUSIONS
Fistula and pre-salvage smoking were associated with stricture post-salvage laryngectomy. No factors were associated with dilation by 1 year. Supraglottic recurrence and smoking were associated with gastrostomy tube dependence. These findings are important for pre-operative counseling prior to salvage laryngectomy.
LEVEL OF EVIDENCE
Level 4 Laryngoscope, 131:1229-1234, 2021.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1229-1234Subventions
Organisme : NCATS NIH HHS
ID : 5TL1TR002242-02
Pays : United States
Informations de copyright
© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).
Références
Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013;31:845-852. https://doi.org/10.1200/JCO.2012.43.6097.
The Department of Veteran's Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991;324:1685-1690. https://doi.org/10.1056/NEJM199106133242402.
Forastiere AA, Ismaila N, Lewin JS, et al. Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2017;36:1143-1169. https://doi.org/10.1200/JCO.2017.75.7385.
Hasan Z, Dwivedi RC, Gunaratne DA, Virk SA, Palme CE, Riffat F. Systematic review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg Oncol 2017;43:42-51. https://doi.org/10.1016/j.ejso.2016.05.017.
Sweeny L, Golden JB, White HN, Magnuson JS, Carroll WR, Rosenthal EL. Incidence and outcomes of stricture formation postlaryngectomy. Otolaryngol Head Neck Surg off J Am Acad Otolaryngol-Head Neck Surg. 2012;146:395-402. https://doi.org/10.1177/0194599811430911.
Petersen JF, Pézier TF, van Dieren JM, et al. Dilation after laryngectomy: incidence, risk factors and complications. Oral Oncol 2019;91:107-112. https://doi.org/10.1016/j.oraloncology.2019.02.025.
Withrow KP, Rosenthal EL, Gourin CG, et al. Free tissue transfer to manage salvage Laryngectomy defects after organ preservation failure. Laryngoscope 2007;117:781-784. https://doi.org/10.1097/MLG.0b013e3180332e39.
Sandulache VC, Vandelaar LJ, Skinner HD, et al. Salvage Total Laryngectomy following external beam radiation therapy: a 20 year experience. Head Neck 2016;38:E1962-E1968. https://doi.org/10.1002/hed.24355.
Petersen JF, Arends CR, van der Noort V, et al. Laryngo-esophageal dysfunction free survival and propensity score matched analysis comparing organ preservation and total laryngectomy in hypopharynx cancer. Oral Oncol 2019;95:143-149. https://doi.org/10.1016/j.oraloncology.2019.06.018.
Worley ML, Graboyes EM, Blair J, et al. Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer. Head Neck 2019;41:865-870. https://doi.org/10.1002/hed.25367.
Terrell JE, Ronis DL, Fowler KE, et al. Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Neck Surg 2004;130:401-408. https://doi.org/10.1001/archotol.130.4.401.
Robertson SM, Yeo JCL, Dunnet C, Young D, MacKenzie K. Voice, swallowing, and quality of life after total laryngectomy-results of the west of Scotland laryngectomy audit. Head Neck 2012;34:59-65. https://doi.org/10.1002/hed.21692.
Mays AC, Worley M, Ackall F, D'Agostino R, Waltonen JD. The association between gastrostomy tube placement, poor post-operative outcomes, and hospital re-admissions in head and neck cancer patients. Surg Oncol 2015;24:248-257. https://doi.org/10.1016/j.suronc.2015.08.005.
Dziegielewski PT, Boyce BJ, Manning AM, et al. Predictors and costs of readmissions at an academic head and neck surgery service. Head Neck 2016;38:E502-E510. https://doi.org/10.1002/hed.24030.
Birkeland AC, Beesley L, Bellile E, et al. Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma. Head Neck 2017;39:2512-2518. https://doi.org/10.1002/hed.24918.
Rosko AJ, Birkeland AC, Bellile E, et al. Hypothyroidism and wound healing after salvage laryngectomy. Ann Surg Oncol 2018;25:1288-1295. https://doi.org/10.1245/s10434-017-6278-4.
Vu KN, Day TA, Gillespie MB, et al. Proximal esophageal stenosis in head and neck cancer patients after total laryngectomy and radiation. ORL J Otorhinolaryngol Relat Spec 2008;70:229-235. https://doi.org/10.1159/000130870.
van der Putten L, de Bree R, Kuik DJ, et al. Salvage laryngectomy: oncological and functional outcome. Oral Oncol 2011;47:296-301. https://doi.org/10.1016/j.oraloncology.2011.02.002.
Fung K, Teknos TN, Vandenberg CD, et al. Prevention of wound complications following salvage laryngectomy using free vascularized tissue. Head Neck 2007;29:425-430. https://doi.org/10.1002/hed.20492.
Silverman DA, Puram SV, Rocco JW, Old MO, Kang SY. Salvage laryngectomy following organ-preservation therapy - an evidence-based review. Oral Oncol 2019;88:137-144. https://doi.org/10.1016/j.oraloncology.2018.11.022.
Hernán MA. The hazards of hazard ratios. Epidemiol Camb Mass 2010;21:13-15. https://doi.org/10.1097/EDE.0b013e3181c1ea43.
Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 2001;127:870-876.
Raol N, Lilley E, Cooper Z, Dowdall J, Morris MA. Preoperative counseling in salvage total laryngectomy: content analysis of electronic medical records. Otolaryngol Neck Surg 2017;157:641-647. https://doi.org/10.1177/0194599817726769.