Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Walla, K.
Clinical Outcome Of Patients After Total Laryngectomy
Humanmedizin; [ Diplomarbeit ] ; 2018. pp. 69
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Weiland Thomas
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- Abstract:
- Introduction: Total laryngectomy (TL), the procedure in which the larynx is completely removed, results in total separation of respiratory and upper digestive tract and loss of voice. It is most commonly used in the treatment of advanced cancer of the larynx and hypopharynx. Increasingly, these patients are being managed with organ-sparing protocols using radiotherapy and chemotherapy. The aim of the present study was to review complication, recurrence and survival rates following TL and gain insight into the recent standards of voice rehabilitation. Methods: In a retrospective study, patients who had undergone TL between 01.01.2002 and 16.01.2018 were identified and reviewed via the electronic database "MEDOCS" of the Department of Otolaryngology, University Hospital of Graz. Clinicopathological data was collected and evaluated. Results: A total of 103 patients met the inclusion criteria. 101 patients had been treated due to cancer, and 2 due to chronic aspiration. 88 of the cancer patients were men and 13 women, with a median age of 63 years. Primary cancer involved the larynx in 72 and the hypopharynx in 22 cases. 13 patients were treated with salvage laryngectomy. Overall complication rate was 58%, and the most common complication was development of pharyngocutaneous fistula in 29 patients. Survival rate was at 83% after one year and 64% after three years. Recurrence developed in 30 patients after a median of 6 months. In 48 patients a voice prosthesis was implanted, with a mean time range of 148 days between replacements. Alaryngeal speech was achieved by use of esophageal speech in 43 patients, of tracheoesophageal speech in 32, of an electrolarynx in 8 and of more than one method in 28. Conclusion: TL remains the preferred initial approach to treat T4a laryngeal and hypopharyngeal cancer. We found survival and complication rates comparable to results found in current literature. While tracheo-esophageal speech by voice prosthesis is considered the gold standard, esophageal speech can achieve good results without the risk of complications and the frequent prosthesis replacements.