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Vol. 72. Issue 6.
Pages 352-358 (November - December 2021)
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Vol. 72. Issue 6.
Pages 352-358 (November - December 2021)
Original article
Comparison of Patients With Total and Salvage Laryngectomy
Comparación de pacientes con laringectomía total primaria y de rescate
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Laura Acevedo Ortiza,b,
Corresponding author
lauracvdo@gmail.com

Corresponding author.
, Gabriel Alejandro Aguilera Aguileraa,b, Marta Lasierra Concellóna,b, Mariela Andrea Carboni Muñoza,b, Leandro Andreu Menciaa,b, Josep Soteras Ollea,b, Begoña Garcia Gonzaleza,b, Francisco Javier Galindo Ortegoa,b
a Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, Spain
b Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, Spain
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Tables (3)
Table 1. Clinical-pathological Characteristics of Patients.
Table 2. Postoperative Complications.
Table 3. Comparison Between Primary and Salvage Total Laryngectomy.
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Abstract
Introduction and objectives

Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival.

Methods

The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death.

Results

The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P = .000) and between fistula and infection (P = .000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P = .038), T4 (P = .026), lymphovascular invasion (P = .019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P = .005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P = .026).

Conclusions

Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.

Keywords:
Laryngeal cancer
Total laryngectomy
Prognosis
Resumen
Introducción y objetivos

La laringectomía total (LT) es uno de los tratamientos disponibles en los carcinomas de laringe localmente avanzados o como rescate ante el fracaso de la preservación de órgano, logrando altas tasas de supervivencia y escasas complicaciones. El objetivo de nuestro trabajo es analizar los resultados oncológicos obtenidos, comparándolos con la literatura actual y analizando sus complicaciones y supervivencia.

Métodos

Se incluyeron 62 pacientes con carcinoma primario de laringe tratados mediante LT primaria o de rescate entre los años 2003 y 2019. Analizamos las características demográficas, clínicas y anatomopatológicas, el estadio tumoral, los tratamientos complementarios, las complicaciones postoperatorias, las recidivas locorregionales, las metástasis y las causas de muerte.

Resultados

Los pacientes tenían una edad media de 64 años, 90,3% eran hombres, 96,8% eran fumadores y 43,5% tenían pluripatología. El 82,3% tenían un estadio localmente avanzado. El 71% se les realizó LT primarias y el 29% de rescate. El 59,6% se les practicó vaciamiento cervical asociado. El 30,6% tenían invasión linfovascular, el 30,6% invasión perineural y 14,5% afectación de márgenes. Durante el seguimiento 17,7% presentaron una recidiva locoregional y 11,3% metástasis a distancia. En cuanto a tratamientos complementarios el 56,4% de los pacientes recibieron tratamiento adyuvante. La incidencia de hemorragia fue 11,3%, de infección 14,5% y de fístula faringocutánea 21%. Hubo significación estadística entre la fístula y la hemorragia (p = 0,000) e infección (p = 0,000). No se encontraron diferencias estadísticamente significativas entre los factores estudiados de la LT primaria y de rescate. La supervivencia global fue a los 3 años de 92% y los 5 años de 88%, encontrando significación estadística con el estadio localmente avanzado (p = 0,038), los T4 (p = 0,026), la invasión linfovascular (p = 0,019) y la afectación de más de 3 ganglios linfáticos en la anatomía patológica (p = 0,005). En el análisis multivariante la única variable que mostró una relación significativa fue la invasión linfovascular (p = 0,026).

Conclusiones

Aunque la preservación de órgano es un objetivo primordial, la LT sigue siendo un tratamiento referente en los carcinomas localmente avanzados y como rescate ante el fracaso de la terapia médica o cirugía parcial.

Palabras clave:
Cáncer de laringe
Laringectomía total
Pronóstico

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