Our Summary

The practice of completely removing the larynx (voice box) to treat severe laryngeal and hypopharyngeal cancer has dropped significantly in developed countries. Instead, they’re using less invasive procedures like laser or robotic surgery, or non-surgical treatments like chemo-radiation. However, in developing countries where healthcare resources are scarce, especially for cancer treatment, this full removal surgery is still the go-to option.

One severe complication of this surgery is the recurrence of cancer around the stoma - the hole made in the neck for breathing after the larynx is removed. Studies have found this happens in about 6.6% of cases, mostly within two years, and is associated with a very high death rate (over 80%).

The chances of this complication increase if the patient had a tracheostomy (a hole made in the windpipe to aid breathing) before treatment, if the original tumor was in specific locations, if there was cancerous tissue left after surgery, or if the cancer had spread to the lymph nodes.

Treatment options for this complication are limited and usually most effective if the recurrence is caught early, which is rare. If the disease is at an advanced stage, the treatment is usually just to relieve symptoms, not to cure.

Therefore, efforts are made to reduce or prevent the known risk factors for this complication when carrying out the full larynx removal surgery. In particular, removing lymph nodes in the central part of the neck (around the windpipe) is very important in preventing this complication, especially in cases of large tumors that have spread beyond the larynx or if the patient had a tracheostomy before treatment.

In summary, more research is needed to establish guidelines for the correct removal of these central neck lymph nodes during larynx removal surgery, as a way to prevent this severe complication.

FAQs

  1. What is the primary treatment for advanced laryngo-hypopharyngeal cancer in developing countries?
  2. What are the major risk factors for peristomal recurrence (PSR) after a total laryngectomy?
  3. What role does central compartment lymph node dissection play in PSR prevention?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laryngectomy is to be vigilant about monitoring for any signs of peristomal recurrence (PSR), as it is a serious complication that can have high mortality rates. Patients should report any new or worsening symptoms around the stoma site to their healthcare provider promptly for evaluation and treatment. Additionally, patients should follow their doctor’s recommendations for regular follow-up appointments and surveillance to catch any potential issues early.

Suitable For

Patients who are typically recommended laryngectomy are those with advanced laryngo-hypopharyngeal cancer who have not responded to other treatment options such as transoral laser or robotic surgery, or nonsurgical bio-chemo-radiotherapy. Patients in the developing world where healthcare resources are limited may also be recommended laryngectomy as it remains the treatment of choice in these regions. Patients with peristomal recurrence, a serious complication associated with primary total laryngectomy, may also be recommended laryngectomy for treatment. The major risk factors for peristomal recurrence include pretreatment tracheostomy, specific primary tumor subsites, positive surgical margins, and presence of nodal metastasis. Treatment options for peristomal recurrence are limited, with surgery being the most successful option, especially when diagnosed at an early stage. Patients with advanced-stage disease may undergo palliative laryngectomy. Research is ongoing to develop guidelines for proper dissection of central compartment lymph nodes during laryngectomy to prevent peristomal recurrence.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with advanced laryngo-hypopharyngeal cancer.
  2. Treatment options are discussed, including primary total laryngectomy.
  3. Patient undergoes preoperative evaluations and counseling.
  4. Surgery is scheduled and patient prepares for the procedure.

After laryngectomy:

  1. Patient undergoes the laryngectomy procedure.
  2. Recovery period in the hospital, which may include speech therapy and rehabilitation.
  3. Patient adjusts to the changes in speech and swallowing post-surgery.
  4. Follow-up appointments with healthcare providers to monitor healing and adjust treatment as needed.
  5. Potential complications such as peristomal recurrence may arise and require further treatment.
  6. Long-term management of side effects and potential complications, as well as ongoing monitoring for recurrence.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with laryngectomy surgery?

  2. How long is the recovery process after laryngectomy surgery, and what can I expect during this time?

  3. Will I need any additional treatments, such as radiation or chemotherapy, after laryngectomy surgery?

  4. What kind of support and resources are available for patients who have undergone laryngectomy surgery, such as speech therapy or support groups?

  5. Are there any specific lifestyle changes or adjustments I will need to make after laryngectomy surgery?

  6. What is the likelihood of peristomal recurrence (PSR) after laryngectomy surgery, and what steps can be taken to reduce this risk?

  7. How frequently should I schedule follow-up appointments to monitor for any potential complications or recurrence?

  8. Are there any specific signs or symptoms I should watch out for that may indicate a complication or recurrence after laryngectomy surgery?

  9. What are the long-term implications of laryngectomy surgery for my overall health and quality of life?

  10. Are there any clinical trials or research studies that I may be eligible to participate in to further advance the understanding and treatment of laryngectomy surgery?

Reference

Authors: Bradley PJ. Journal: Curr Opin Otolaryngol Head Neck Surg. 2023 Apr 1;31(2):94-104. doi: 10.1097/MOO.0000000000000854. Epub 2022 Nov 17. PMID: 36730566