Objective To evaluate the functional outcomes after total laryngectomy (TLE) for a dysfunctional larynx in patients with head
and neck cancer that is in complete remission after (chemo)radiotherapy.
Design Retrospective cohort study.
Tertiary comprehensive cancer center.
Patients The study included 25 patients from a cohort of 217 consecutive patients
with TLE who were treated between January 2000 and July 2010. The inclusion criteria for this subgroup analysis were complete
remission and functional problems for which TLE was considered to be the only resolution. Quality of life assessment was carried
out using the European Organization for Research and Treatment of Cancer Quality of Life C30 and Head and Neck Module 35 questionnaires
and an additional study-specific questionnaire covering functional aspects, such as swallowing and dyspnea, in more detail.
Main Outcome Measures Morbidity, mortality, and functional outcomes.
Results The indication
for TLE was chronic aspiration with or without recurrent pneumonia (n = 15 [60%]), debilitating dyspnea (n = 8 [32%]), and
persistent profuse hemorrhage (radiation ulcer) (n = 2 [8%]). After TLE, 14 of the 25 patients (56%) had 20 major postoperative
complications, including 11 pharyngocutaneous fistulas, requiring additional treatment. Tube feeding and recurrent pneumonia
incidence had decreased from 80% and 28% to 29% and 0%, respectively, 2 years after surgery. Prosthetic voice rehabilitation
was possible in 19 patients (76%). Two years after surgery, 10 of 14 patients (71%) still reported TLE-related pulmonary problems
despite the consistent use of a heat and moisture exchanger. The 5-year overall survival rate was 35%.
Total laryngectomy for a dysfunctional larynx tends to have a high complication rate. However, in this study, the initial
functional problems (aspiration, recurrent pneumonia, and dyspnea) did not recur. Tube feeding was significantly reduced,
and the quality of life of the surviving patients appeared to be reasonable.