Our Summary

This research paper looks at the results of a surgery called salvage total laryngectomy, a last resort treatment for throat cancer, specifically in the voice box area. The researchers looked at patients who had this surgery between 1999 and 2018. They found that the most common cancer site was the glottis, which is the middle part of the voice box. Most of the cases were early stage.

The survival rates two years after the surgery was 71%, but this dropped to 45% five years after the surgery. Disease-free survival rates were slightly lower - 65% after two years and 42% after five years.

The surgery also had a complication rate of 29% where a hole formed between the throat and skin.

The researchers concluded that more than half of the patients would not make it beyond five years after the surgery. The most common reason for this was the cancer coming back in the same area. Because of this, the researchers suggest that doctors should consider removing more tissue from the neck, including the middle and sides, in patients with early stage voice box cancer who have an advanced recurrence.

FAQs

  1. What was the survival rate for patients who underwent salvage total laryngectomy in this study?
  2. What was the most common primary tumour site identified in the study of salvage total laryngectomy?
  3. What is the recommended treatment for patients with early laryngeal cancer who present with an advanced recurrence, based on the study’s findings?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to practice good neck and throat care post-surgery, including regular cleaning and monitoring for any signs of infection or complication. It is also important for patients to follow up with their healthcare team for regular check-ups and screenings to monitor for any signs of recurrence or new cancer development. Additionally, patients should be mindful of their speech and swallowing abilities post-surgery and seek out speech therapy or other support services if needed.

Suitable For

Patients who are typically recommended for laryngectomy include those with advanced laryngeal cancer that has not responded to other treatments such as chemotherapy and radiation therapy, as well as those with recurrent laryngeal cancer. In particular, patients with early stage (T1-T2) disease who present with an advanced recurrence may benefit from salvage total laryngectomy. Additionally, patients with high-risk features such as extensive primary tumour involvement, extralaryngeal spread, or cartilage invasion may also be candidates for laryngectomy. It is important for patients to be evaluated on a case-by-case basis by a multidisciplinary team to determine the most appropriate treatment plan.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with laryngeal cancer, often presenting with symptoms such as hoarseness, difficulty swallowing, and throat pain.
  2. Patient undergoes various tests and imaging studies to determine the extent of the cancer and whether laryngectomy is necessary.
  3. Patient may undergo chemotherapy and/or radiation therapy as part of their treatment plan.
  4. If the cancer does not respond to these treatments or recurs, patient may be recommended for salvage total laryngectomy.

After laryngectomy:

  1. Patient undergoes surgical removal of the larynx, resulting in permanent loss of voice.
  2. Patient may require a tracheostomy tube to help with breathing.
  3. Patient undergoes rehabilitation to learn how to speak using alternative methods such as esophageal speech or a voice prosthesis.
  4. Patient may experience physical and emotional challenges adjusting to life without a larynx.
  5. Patient undergoes regular follow-up appointments and surveillance to monitor for recurrence or complications.
  6. Long-term survival rates post-salvage total laryngectomy are relatively low, with the most common cause of failure and death being regional recurrence.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with salvage total laryngectomy?
  2. What is the success rate of salvage total laryngectomy in terms of overall survival and disease-free survival?
  3. What is the recommended follow-up care after undergoing salvage total laryngectomy?
  4. What are the potential long-term effects on speech and swallowing function after undergoing laryngectomy?
  5. How soon after the initial treatment failure should salvage total laryngectomy be considered?
  6. Are there any alternative treatment options available for patients who may not be suitable candidates for salvage total laryngectomy?
  7. What is the expected recovery time and rehabilitation process following salvage total laryngectomy?
  8. How often will follow-up appointments be necessary to monitor for recurrence or complications?
  9. Are there any lifestyle changes or modifications that should be made after undergoing salvage total laryngectomy?
  10. What support resources are available for patients and their families during the recovery process?

Reference

Authors: Tsetsos N, Poutoglidis A, Vlachtsis K, Stavrakas M, Nikolaou A, Fyrmpas G. Journal: J Laryngol Otol. 2021 Aug;135(8):729-736. doi: 10.1017/S0022215121001687. Epub 2021 Jul 5. PMID: 34219631