Background and objective: Total laryngectomy has
the major role in laryngeal and hypopharyngeal
cancer treatment. The most common post-operative
complication was pharyngocutaneous fistula
particularly the patients who undergoing total
laryngectomy after previous radiotherapy. This study
aimed to evaluate the incidence of pharyngocutaneous
fistula and also the overall survival after surgery.
Method: This is the retrospective study of patients
who underwent total laryngectomy or total laryngopharyngectomy
between 2014 and 2018 at National
Cancer Institute, Thailand.
Results: Forty-two male patients were included in
the study. The primary total laryngectomy accounted
for 66.7% of the laryngectomy procedures. Moreover,
there was no patient experienced post-operative
pharyngocutaneous fistula. In the follow-up period,
there were 11 patients (26.2%) had recurrent disease.
The most common pattern of recurrent was lung
metastasis.The patients who underwent primary
surgery had 3-year DFS, 5-year DFS, 3-year OS and
5-year OS as 79.4%, 79.4%, 77.3% and 65.6%,
respectively. While the salvage surgery group had
lesser surival outcome. This group had 3-year DFS ,
5-year DFS , 3-year OS and 5-year OS about 46.5%
, 42. 3% , 62. 6% and 59. 7% , respecti vely.
Nonetheless,there was statistically significant in DFS (
log rank test, p< 0.05) between both groups but not
in OS ( log rank test, p=0.66). Perineural invasion and
extranodal extension were the significant negative
impact factor in DFS.Conclusion: Selecting the patients for appropriate
surgical candidates together with repairing the
neopharynx with zipper technique or PMM flap
resulted no pharyngocutaneous fistula incidence in
this study. Moreover, the post-operative radiotherapy
or post-operative chemoradiation after surgery
encouraged the survival outcome in primary surgery
group in this study.
Keywords
Total laryngecomy Laryngeal cancer Hypopharyngeal cancer Pharyngocutaneous fistula