Premium
Predictors of Stricture and Swallowing Function Following Salvage Laryngectomy
Author(s) -
Schuman Ari D.,
Birkeland Andrew C.,
Farlow Janice L.,
Lyden Teresa,
Blakely Anna,
Spector Matthew E.,
Rosko Andrew J.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29215
Subject(s) - medicine , laryngectomy , swallowing , surgery , salvage therapy , gastrostomy , retrospective cohort study , fistula , hazard ratio , gastrostomy tube , larynx , confidence interval , chemotherapy
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