Our Summary

This research paper reviews the complications from a surgical procedure called salvage total laryngectomy. The procedure is a last resort treatment for laryngeal cancer patients if the first treatment, which aims to save the larynx (voice box), fails. The researchers looked at 50 studies conducted between 2000 and 2015, involving more than 3000 patients. They found that the most common complication was pharyngocutaneous fistula - a hole between the throat and the skin - that occurred in almost 29% of patients. Other complications included wound problems, swallowing difficulties, bleeding, and narrowing of the throat and stoma (an opening made in the neck for breathing). Overall, about 67.5% of patients experienced some sort of complication.

FAQs

  1. What is salvage total laryngectomy and when is it used?
  2. What are the most common complications experienced after salvage total laryngectomy?
  3. What percentage of patients experienced complications after the salvage total laryngectomy procedure?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laryngectomy is to closely follow post-operative care instructions to reduce the risk of complications. This may include proper wound care, maintaining good oral hygiene, practicing swallowing exercises, and attending follow-up appointments as recommended. Being proactive in managing potential complications can help improve the overall outcome of the surgery and recovery process.

Suitable For

Patients who are typically recommended for laryngectomy are those with advanced laryngeal cancer that has not responded to other treatments such as radiation therapy or chemotherapy. These patients may have tumors that are too large or invasive to be effectively treated with less invasive methods. Additionally, patients with recurrent laryngeal cancer after initial treatment may also be candidates for laryngectomy.

In some cases, patients with benign conditions such as severe laryngeal stenosis (narrowing of the airway) or severe laryngeal trauma may also be recommended for laryngectomy. Ultimately, the decision to undergo laryngectomy is made on a case-by-case basis by a multidisciplinary team of healthcare providers including otolaryngologists (ENT specialists), oncologists, speech therapists, and other specialists.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with laryngeal cancer and undergoes initial treatments such as radiation therapy or chemotherapy.
  2. If initial treatments are unsuccessful, patient may be recommended for salvage total laryngectomy.
  3. Patient undergoes pre-operative assessments and consultations with medical team to prepare for surgery.
  4. Surgery is performed to remove the larynx and create a stoma in the neck for breathing.

After laryngectomy:

  1. Patient wakes up from surgery with a tracheostomy tube for breathing.
  2. Patient may experience pain, difficulty swallowing, and changes in speech and voice.
  3. Patient undergoes post-operative care and rehabilitation to learn how to communicate, swallow, and care for their stoma.
  4. Patient may experience complications such as pharyngocutaneous fistula, wound problems, and swallowing difficulties.
  5. Patient continues to have follow-up appointments and may require additional treatments or interventions for complications.
  6. Patient adjusts to life without a larynx and may need support for emotional and psychological challenges.

What to Ask Your Doctor

  1. What are the potential complications of a laryngectomy procedure?
  2. How common are complications like pharyngocutaneous fistula and how are they typically treated?
  3. What is the likelihood of experiencing swallowing difficulties or other issues post-surgery?
  4. How will my ability to communicate be affected after a laryngectomy?
  5. What can I do to prepare for life after a laryngectomy in terms of speech therapy and rehabilitation?
  6. Are there any long-term risks or side effects associated with a laryngectomy that I should be aware of?
  7. How often will I need follow-up appointments and monitoring after the procedure?
  8. Are there any lifestyle changes or adjustments I should make following a laryngectomy?
  9. Are there support groups or resources available for patients who have undergone a laryngectomy?
  10. What can I expect in terms of recovery time and potential challenges during the healing process?

Reference

Authors: Hasan Z, Dwivedi RC, Gunaratne DA, Virk SA, Palme CE, Riffat F. Journal: Eur J Surg Oncol. 2017 Jan;43(1):42-51. doi: 10.1016/j.ejso.2016.05.017. Epub 2016 May 27. PMID: 27265037