Preoperative tracheotomy in the treatment of upper airway obstruction of patients with advanced stage supraglottic carcinoma

Hongli Gong; Jianfang Wu; Ji Sun; Chi-Yao Hsueh; Chunping Wu; Lei Tao; Haitao Wu; Ming Zhang; Jian Zhou; Liang Zhou

doi:10.1016/j.amjoto.2022.103381

Preoperative tracheotomy in the treatment of upper airway obstruction of patients with advanced stage supraglottic carcinoma

Am J Otolaryngol. 2022 May-Jun;43(3):103381. doi: 10.1016/j.amjoto.2022.103381. Epub 2022 Feb 3.

Authors

Hongli Gong¹, Jianfang Wu², Ji Sun³, Chi-Yao Hsueh¹, Chunping Wu¹, Lei Tao¹, Haitao Wu¹, Ming Zhang¹, Jian Zhou¹, Liang Zhou⁴

Affiliations

¹ Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
² Department of Nursing, Eye & ENT Hospital, Fudan University, Shanghai 200031, China. Electronic address: wujianfangeent@126.com.
³ Department of Pathology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China. Electronic address: Ji.sun@fdeent.org.
⁴ Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China. Electronic address: zhoulent@126.com.

PMID: 35339772
DOI: 10.1016/j.amjoto.2022.103381

Abstract

Background: Preoperative tracheotomy is an effective option that secures upper airway patency in laryngeal carcinoma patients suffering from upper airway obstruction, but the influence of this treatment on oncologic outcomes of laryngeal carcinoma remains controversial. The purpose of this study was to determine the impact of preoperative tracheotomy on overall survival in supraglottic carcinoma patients with tumor obstruction of the upper airway, and explore the potential causes.

Materials and methods: This retrospective study collected 243 consecutive patients with advanced stage supraglottic carcinoma from 2005 to 2010. Preoperative tracheotomy in the management of upper airway obstruction in patients with supraglottic carcinoma was analyzed.

Results: The mean age was 60.9 years at diagnosis, with men accounting for 98.4% of all patients. Thirty nine (16.0%) patients presenting with tumor obstruction of the upper airway required preoperative tracheotomy. T4 stage patients had higher rate of tracheotomy than those of patients with T3 stage (36.8% vs 12.2%). Patients with upper airway obstruction presented with greater tumor area compared with patients without (13.7 cm² vs 9.0 cm²). The optimal cutoff value of tumor area for tracheotomy and OS rate were both at 10 cm². Supraglottic patients with upper airway obstruction receiving preoperative tracheotomy had poorer OS rate compared with patients without. T stage and tumor area were correlated with upper airway obstruction, and these two variables were independent predictors of OS rate in supraglottic carcinoma patients.

Conclusions: Advanced stage supraglottic carcinoma patients with upper airway obstruction undergoing preoperative tracheotomy experienced worse overall survival. Advanced T stage and greater tumor size were associated with upper airway obstruction, indicating that the negative influence of tumor obstruction on survival may be cause by these two preoperative variables. Therefore, preoperative tracheotomy acts only as an alternative procedure, and is not a prognostic agent.

Keywords: Overall survival; Supraglottic carcinoma; Tracheotomy; Tumor size; Upper airway obstruction.

MeSH terms

Airway Obstruction* / etiology
Airway Obstruction* / surgery
Carcinoma* / pathology
Humans
Laryngeal Neoplasms* / complications
Laryngeal Neoplasms* / pathology
Laryngeal Neoplasms* / surgery
Male
Middle Aged
Retrospective Studies
Tracheotomy