Journal
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK
Volume 38, Issue -, Pages E1962-E1968Publisher
WILEY
DOI: 10.1002/hed.24355
Keywords
laryngectomy; squamous cell carcinoma; recurrence; salvage; complications; disease-free interval; fistula; radiotherapy; free flap
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Background. The purpose of this study was to present our evaluation of the clinical and functional outcomes after salvage total laryngectomy (STL). Methods. We conducted a retrospective review of 218 patients who underwent STL between 1994 and 2014. Results. Seventy percent of patients originally had T1 or T2, N0 tumors and 73% had definitive external-beam radiotherapy (EBRT) alone. A majority utilized tracheoesophageal prosthesis (77%) and were gastrostomy free (80%) at last follow-up. The 5-year disease control and overall survival (OS) rates were 65% and 57%, respectively. Patients with a disease-free interval after initial treatment <2 years were more likely to develop a recurrence (p = .001) and die of disease (p = .032) after STL. The disease-free interval after EBRT impacted disease control (p < .001), with 5-year disease control of 92% for >5-year disease-free interval and 60% for <2-year disease-free interval. Conclusion. Most patients remain disease-free after STL, achieve intelligible tracheoesophageal speech, and maintain an oral diet. Delayed recurrence after initial treatment portends better survival and may indicate a distinct biological profile. (C) 2016 Wiley Periodicals, Inc.
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