Our Summary

This research paper is about a type of surgery called supracricoid laryngectomies (SCLs), which is used to treat certain types of throat cancer. This surgery aims to save as much of the larynx (voice box) as possible. However, this procedure is not commonly used in many countries due to its complex aftercare and the varied outcomes it produces.

The paper reviews existing literature on the outcomes of this surgery, specifically looking at how long patients stay in hospital, when feeding tubes are removed, and when a tracheotomy (a surgical opening in the windpipe) is reversed, if needed. The results vary widely across different studies, which could be due to various factors, including different healthcare systems in different countries.

The paper also reviews studies on patients’ ability to swallow and speak after surgery, which again shows varied results and a lack of agreement on how to measure these abilities. The tools used in these studies often aren’t designed to measure the substitute voice that patients may have after surgery.

The research found that patients often report satisfactory quality of life in terms of their ability to speak and swallow, but these results also vary widely. As a result, the paper calls for clearer guidelines on how to manage patients after surgery, including when to remove tracheal tubes and feeding tubes, how to assess patients’ ability to speak and swallow, and when and how to provide rehabilitation.

FAQs

  1. What is a supracricoid laryngectomy and why is it not commonly used?
  2. What factors contribute to the varied outcomes of supracricoid laryngectomies?
  3. What does the research suggest about post-surgery care and rehabilitation for patients who have undergone a supracricoid laryngectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to follow a strict post-operative care plan, including regular follow-up appointments with healthcare providers, speech therapy, and swallowing therapy. It is important to adhere to any dietary restrictions, practice good oral hygiene, and avoid smoking or alcohol consumption to promote healing and recovery. Additionally, staying physically active and maintaining a positive attitude can greatly improve overall outcomes after laryngectomy surgery.

Suitable For

Patients who are typically recommended for laryngectomy, including supracricoid laryngectomies, are those with advanced stage 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 too close to critical structures in the larynx to be safely removed without a laryngectomy.

Other types of patients who may be recommended for laryngectomy include those with recurrent laryngeal cancer, those with cancer that has spread to the larynx from other parts of the body, or those with severe laryngeal dysplasia (pre-cancerous changes in the larynx).

It is important for patients considering laryngectomy to discuss their treatment options with their healthcare provider to determine if this surgery is the best course of action for their specific situation. It is also important for patients to understand the potential risks and benefits of laryngectomy, as well as the potential impact on their quality of life, including changes in speech and swallowing abilities.

Timeline

Overall, the timeline of what a patient experiences before and after a laryngectomy can be summarized as follows:

Before surgery:

  1. Diagnosis of throat cancer
  2. Consultation with healthcare team to discuss treatment options
  3. Preparation for surgery, including pre-operative tests and evaluations

After surgery:

  1. Immediate recovery period in hospital, which can vary in length depending on individual factors and complications
  2. Removal of feeding tube once patient is able to swallow
  3. Potential reversal of tracheotomy if needed
  4. Speech and swallowing therapy to help patients adapt to changes in their ability to communicate and eat
  5. Adjustment to new ways of speaking, such as using a voice prosthesis or other devices
  6. Ongoing follow-up care and monitoring for potential complications or recurrence of cancer

It is important for healthcare providers to work closely with patients before and after laryngectomy to provide comprehensive care and support throughout the entire process.

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 a laryngectomy surgery?
  2. How long will I need to stay in the hospital after the surgery?
  3. When will my feeding tube be removed, and when can I start eating and drinking normally again?
  4. Will I need a tracheotomy after the surgery, and if so, when can it be reversed?
  5. What kind of rehabilitation and support will be available to help me regain my ability to speak and swallow?
  6. How will my ability to communicate be affected after the surgery, and what options are available for speech rehabilitation?
  7. What kind of long-term follow-up care will I need after the surgery?
  8. Are there any lifestyle changes or adjustments I will need to make after the surgery?
  9. Can you provide information on support groups or resources for patients who have undergone a laryngectomy?
  10. Are there any specific guidelines or recommendations for managing my care and recovery after the surgery?

Reference

Authors: Schindler A, Pizzorni N, Mozzanica F, Fantini M, Ginocchio D, Bertolin A, Crosetti E, Succo G. Journal: Eur Arch Otorhinolaryngol. 2016 Nov;273(11):3459-3475. doi: 10.1007/s00405-015-3822-3. Epub 2015 Nov 6. PMID: 26545378