Our Summary

This research article is about a type of surgery called salvage total laryngectomy, which is often used for patients who have throat cancer that keeps coming back or won’t go away after they’ve had radiation or chemoradiation treatment. The article looks at how often this surgery is used in major trials that try to preserve the organ, how long patients live after the surgery, what factors can predict the surgery outcomes, and the rate of complications from the surgery. It also discusses when to use other procedures like elective neck dissection (surgery to remove lymph nodes in the neck) and free tissue transfer (moving tissue from one part of the body to another) for reconstruction in patients who undergo this surgery.

FAQs

  1. What is salvage laryngectomy and when is it indicated?
  2. What factors predict the outcomes of a salvage laryngectomy?
  3. What roles do elective neck dissection and free tissue transfer play in the process of salvage laryngectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to follow a strict post-operative care plan to minimize the risk of complications such as pharyngocutaneous fistula. This may include proper wound care, avoiding smoking and alcohol consumption, and attending regular follow-up appointments with healthcare providers. Additionally, patients should be aware of the potential benefits of elective neck dissection and free tissue transfer for reconstruction in order to optimize outcomes after surgery.

Suitable For

Patients who are typically recommended for laryngectomy include those with recurrent or persistent laryngeal cancer after radiation or chemoradiation treatment. These patients may have failed organ preservation treatments and may require salvage total laryngectomy to remove the cancerous tissue. Other factors that may indicate the need for laryngectomy include advanced stage laryngeal cancer that is not amenable to other treatments, such as chemotherapy or radiation therapy. Patients with significant functional impairment of the larynx, such as severe voice changes or difficulty breathing, may also be candidates for laryngectomy. Additionally, patients with certain types of laryngeal cancer, such as glottic or supraglottic tumors, may benefit from laryngectomy as a primary treatment option.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with laryngeal cancer and undergoes radiation or chemoradiation treatment.
  2. Patient may experience recurrent or persistent cancer despite treatment.
  3. Patient may undergo further imaging and biopsies to confirm the need for salvage laryngectomy.
  4. Patient may undergo pre-operative counseling and preparation for surgery.

After laryngectomy:

  1. Patient undergoes salvage total laryngectomy surgery to remove the larynx.
  2. Patient may experience temporary or permanent loss of voice.
  3. Patient may require speech therapy to learn new ways of communicating.
  4. Patient may experience changes in swallowing and require dietary modifications.
  5. Patient may undergo reconstruction with free tissue transfer or locoregional flaps.
  6. Patient may experience complications such as pharyngocutaneous fistula.
  7. Patient will require regular follow-up appointments for monitoring and surveillance.
  8. Patient may undergo rehabilitation and support to adjust to life after laryngectomy.

What to Ask Your Doctor

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

  2. How will my ability to speak and swallow be affected after laryngectomy surgery?

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

  4. What is the typical recovery time and rehabilitation process after laryngectomy surgery?

  5. Are there any long-term side effects or limitations I should be aware of after laryngectomy surgery?

  6. How often will I need to follow up with my doctor after laryngectomy surgery?

  7. What are the chances of the cancer returning after laryngectomy surgery?

  8. Will I need any additional procedures, such as neck dissection or reconstruction with free tissue transfer, during laryngectomy surgery?

  9. What factors may affect my prognosis and outcome after laryngectomy surgery?

  10. Are there any support groups or resources available for patients who have undergone laryngectomy surgery?

Reference

Authors: Silverman DA, Puram SV, Rocco JW, Old MO, Kang SY. Journal: Oral Oncol. 2019 Jan;88:137-144. doi: 10.1016/j.oraloncology.2018.11.022. Epub 2018 Nov 29. PMID: 30616784