Oncological outcomes of primary laryngectomy in T4 laryngopharyngeal cancer – study of 76 cases

Introduction:

Primary laryngectomy with postoperative radiotherapy is still the golden standard in treating laryngopharyngeal malignancies in advanced stage. Despite the promising results in some trials, recent studies show inferior long term results of larynx preservation protocols in this subgroup of patients. In the light of this debate, the aim of this study is to present the oncological outcomes of primary laryngectomy in patients with T4a and T4b laryngopharyngeal cancer.

Material and Methods:

Seventy-six patients with pathologically confirmed laryngopharyngeal cancer in T4a (92.2%) and T4b (7.8%) stage underwent primary laryngectomy with post-operative radiotherapy at the University Hospital "Queen Jovanna-ISUL", Medical University – Sofia, Bulgaria. Patients were operated during the period 2015 – 2018 – single surgeon consecutive series. Median follow-up was 30 months.

Results:

Almost all patients were males (98,7%). Approximately half of the patients (48.7%) had transglottic tumors, 25% – supraglottic, 13.2% of the cases were reported with predominantly subglottic invasion and pure pharyngeal tumors were 9.2% of the cases. Seven patients needed pectoralis major flap for reconstruction purposes. Overall survival rate for the follow-up period was 67.1% – 25 (32.9%) patients died, as 10 (13.6%) of those deceased from other conditions such as cardiovascular incidents (4 patients), synchronous malignancies (4 patients) or infections (2 cases). This encompasses a disease-specific mortality rate of 22.7% for the whole group. Additional subgroup analysis is presented.

Conclusion:

Despite the advanced tumor stage, surgical modality could offer significant overall survival rate in patients with laryngopharyngeal cancer and low disease-specific mortality rate.

Publication History

Publication Date:
23 April 2019 (online)