Safety and efficacy of functional laryngectomy for end-stage dysphagia.
Publication/Presentation Date
3-1-2018
Abstract
OBJECTIVES/HYPOTHESIS: To evaluate functional outcomes and complication rate after total laryngectomy (TL) for dysfunctional larynx with end-stage dysphagia.
STUDY DESIGN: Retrospective chart review.
METHODS: Chart review was performed on all patients who underwent TL from January 2008 to July 2016 at a single tertiary academic medical center. Patients who underwent TL for dysfunctional larynx without preoperative evidence of malignancy were included. Main outcome measures were post-TL functional swallowing and speech outcomes, and complication rate.
RESULTS: The study included 19 patients from a cohort of 278 consecutive patients. All patients were previously treated with radiotherapy (RT), whereas 13/19 (68%) previously received chemoradiotherapy. The median time from RT to TL was 10.98 years (range, 0.67-23.94 years). Aspiration was evident preoperatively in 17/19 (89%) patients, with 11 experiencing recurrent aspiration pneumonia. Seventeen of 19 (89%) patients were nil per os (NPO) requiring enteral nutrition. Six of 19 (32%) patients had surgical complications, including three (16%) pharyngocutaneous fistulas. At 3-month and 1-year postoperative follow-up, there was significant improvement in mean Functional Oral Intake Scale (FOIS) score and aspiration, recurrent pneumonia, enteral nutrition, and NPO status rates (P < .05). At 1-year follow-up, no patients were NPO, and only one patient required gastrostomy tube supplementation. Mean FOIS score increased from 1.3 to 6.1 (P = .001). Eight of 13 patients (62%) were actively using a tracheoesophageal prosthesis at 1-year follow-up.
CONCLUSIONS: Laryngectomy for dysfunctional larynx eliminates the morbidity of aspiration while improving diet and reducing gastrostomy tube dependence with an acceptable complication rate.
LEVEL OF EVIDENCE: 4. Laryngoscope, 128:597-602, 2018.
Volume
128
Issue
3
First Page
597
Last Page
602
ISSN
1531-4995
Published In/Presented At
Topf, M. C., Magaña, L. C., Salmon, K., Hamilton, J., Keane, W. M., Luginbuhl, A., Curry, J. M., Cognetti, D. M., Boon, M., & Spiegel, J. R. (2018). Safety and efficacy of functional laryngectomy for end-stage dysphagia. The Laryngoscope, 128(3), 597–602. https://doi.org/10.1002/lary.26760
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
28714539
Department(s)
Administration and Leadership
Document Type
Article