Our Summary

This research paper reviews the medical records of 477 patients who had their voice box removed (total laryngectomy) in two hospitals in the Netherlands. This surgery is often a treatment for larynx cancer. Sometimes after this surgery, the back of the throat (neopharynx) can become narrow or blocked (stenosis), which can make it hard for patients to eat or breathe.

The study found that about 23% of patients needed a procedure to widen the narrowed area (dilation) within five years of their surgery. Women, patients with a specific type of throat tumor (hypopharynx tumor), and patients who had radiation or chemotherapy before or after the surgery were more likely to need this procedure.

The average number of dilation procedures per patient was three, but some patients needed many more. About half of the patients only needed a few dilation procedures, but the other half needed ongoing treatments.

The study also looked at the risks of the dilation procedure. There were major complications in less than 1% of cases, but these complications can be serious, including severe perforation of the esophagus. These complications were more likely to happen during the first few dilation procedures, and also more likely if the patient was under general anesthesia.

The researchers conclude that doctors should be especially careful when doing the first few dilation procedures on new patients. They also suggest that the use of general anesthesia may need to be reconsidered due to the increased risk of complications.

FAQs

  1. What percentage of patients needed a procedure to widen the narrowed area after a total laryngectomy?
  2. What factors were found to increase the likelihood of needing dilation procedures after a total laryngectomy?
  3. What are the potential risks associated with the dilation procedure and how can they be minimized?

Doctor’s Tip

One helpful tip a doctor might give to a patient who has had a laryngectomy is to be aware of the potential for narrowing or blockage in the back of the throat (neopharynx) and to watch for any symptoms such as difficulty swallowing or breathing. It is important for patients to communicate any concerns or changes in symptoms to their healthcare provider promptly. Additionally, patients should follow their healthcare provider’s recommendations for follow-up appointments and screenings to monitor for any potential issues and to address them early on if needed.

Suitable For

Overall, patients who undergo laryngectomy are typically recommended for the surgery if they have larynx cancer that cannot be treated with other methods. Patients who have a hypopharynx tumor, are female, or have had radiation or chemotherapy before or after the surgery may be at higher risk for developing stenosis and requiring dilation procedures. It is important for doctors to closely monitor these patients and consider alternative anesthesia options to minimize the risk of complications during dilation procedures.

Timeline

Before laryngectomy:

  • The patient may experience symptoms such as hoarseness, difficulty swallowing, persistent coughing, and a lump in the throat.
  • The patient undergoes various diagnostic tests such as imaging scans, biopsies, and endoscopies to confirm the diagnosis of larynx cancer.
  • The patient may undergo radiation or chemotherapy as part of their treatment plan.
  • The patient undergoes counseling and education about the surgery and its potential complications.

After laryngectomy:

  • The patient undergoes the total laryngectomy surgery to remove the voice box.
  • The patient may experience temporary or permanent changes in their ability to speak, swallow, and breathe.
  • The patient undergoes rehabilitation to learn new ways of speaking and swallowing.
  • The patient may require dilation procedures to widen the neopharynx if it becomes narrow or blocked.
  • The patient may experience complications such as perforation of the esophagus during dilation procedures.
  • The patient requires ongoing follow-up care and monitoring for recurrence of cancer or other complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laryngectomy include:

  1. What are the potential risks and complications associated with laryngectomy surgery?
  2. What are the chances of developing stenosis in the neopharynx after laryngectomy, and how is it typically treated?
  3. Are there any factors that may increase my risk of needing dilation procedures in the future?
  4. How frequently will I need to undergo dilation procedures, and what is the typical recovery process like?
  5. What are the potential complications of dilation procedures, and how will they be managed if they occur?
  6. Are there any alternative treatments or preventive measures that can help reduce the risk of developing stenosis post-laryngectomy?
  7. How experienced is the medical team in performing dilation procedures, and what measures are in place to minimize the risk of complications?
  8. Will I need to be under general anesthesia for dilation procedures, and what are the pros and cons of this approach?
  9. What long-term follow-up care will be needed to monitor for any potential issues related to stenosis or complications from dilation procedures?
  10. Are there any lifestyle changes or modifications I should consider to help prevent or manage stenosis after laryngectomy?

Reference

Authors: Petersen JF, Pézier TF, van Dieren JM, van der Noort V, van Putten T, Bril SI, Janssen L, Dirven R, van den Brekel MWM, de Bree R. Journal: Oral Oncol. 2019 Apr;91:107-112. doi: 10.1016/j.oraloncology.2019.02.025. Epub 2019 Mar 6. PMID: 30926055