Incidence and outcomes of stricture formation postlaryngectomy

Otolaryngol Head Neck Surg. 2012 Mar;146(3):395-402. doi: 10.1177/0194599811430911. Epub 2011 Dec 13.

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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery*
  • Cohort Studies
  • Confidence Intervals
  • Constriction, Pathologic / epidemiology
  • Constriction, Pathologic / etiology
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Laryngeal Neoplasms / mortality
  • Laryngeal Neoplasms / pathology
  • Laryngeal Neoplasms / surgery*
  • Laryngectomy / adverse effects*
  • Laryngectomy / methods
  • Laryngostenosis / epidemiology*
  • Laryngostenosis / etiology
  • Laryngostenosis / pathology
  • Male
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Odds Ratio
  • Postoperative Complications / epidemiology
  • Postoperative Complications / pathology
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution
  • Survival Analysis