Incidence and outcomes of stricture formation postlaryngectomy.

Academic Article

Abstract

  • OBJECTIVE: Postlaryngectomy stricture formation and dysphagia negatively affect quality of life and result in nutritional compromise. Understanding risk factors and successful treatment strategies may improve treatment outcomes. STUDY DESIGN: Historical cohort study. SETTING: Tertiary care medical center. SUBJECTS AND METHODS: Patients at a tertiary care center who underwent a total laryngectomy between 2003 and 2009 (N = 263) were evaluated in a retrospective manner. Patient demographics, comorbidities, tobacco and alcohol usage, dietary outcomes, feeding tube dependence, and treatment modalities were assessed. Management strategies and outcomes were evaluated. RESULTS: Strictures developed in 19% (n = 49) of patients, and the majority (82%) occurred in the first year. Incidences of stricture formation were similar for primary (19%) and salvage laryngectomy (19%) patients. Patients undergoing salvage laryngectomy were 2 times more likely to be reconstructed with a free flap, whereas those undergoing a primary laryngectomy were 3 times more likely to be closed primarily. Tubed flap reconstruction significantly increased the incidence of stricture formation compared to primary closure (P = .02) in salvage laryngectomy cases. In primary laryngectomy patients, stricture formation did not correlate with flap reconstruction (P = .34) or adjuvant radiation therapy (P = .79). Patients who required a single dilation had better dietary outcomes compared to patients who required serial dilations (P = .14). There was no difference in overall disease-free survival in primary vs salvage laryngectomy patients (P = .95). CONCLUSION: Rates of stricture formation were the same in patients undergoing salvage compared to primary total laryngectomy.
  • Keywords

  • Adult, Age Distribution, Aged, Carcinoma, Squamous Cell, Cohort Studies, Confidence Intervals, Constriction, Pathologic, Disease-Free Survival, Female, Follow-Up Studies, Humans, Incidence, Kaplan-Meier Estimate, Laryngeal Neoplasms, Laryngectomy, Laryngostenosis, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Odds Ratio, Postoperative Complications, Retrospective Studies, Risk Assessment, Sex Distribution, Survival Analysis
  • Digital Object Identifier (doi)

    Author List

  • Sweeny L; Golden JB; White HN; Magnuson JS; Carroll WR; Rosenthal EL
  • Start Page

  • 395
  • End Page

  • 402
  • Volume

  • 146
  • Issue

  • 3