Laryngectomy: complications & survival

Abstract

The larynx is the midline throat structure commonly referred to as the “voice box. It is a complex structure critical to breathing, speaking and the prevention of aspiration (choking). Surgery to remove the larynx is called a laryngectomy and about 150such operations are performed each year in the Netherlands almost exclusively for cancer.

Laryngectomy is a highly invasive operation carried out in a handful of centers with high rates of complications. Perhaps the most important complication is a pharyngocutaneous fistula (PCF). This is where the neck wound fails to heal meaning that saliva leaks from the throat out onto the skin. This complication happens in roughly a third of patients and can be extremely serious:

• PCF on average doubles the length of hospital stay from 16 days to 30 days with half of patients needing at least one return to theatre • PCF almost halves the 5 year overall survival from 44% to 24%.

Given these striking numbers, this thesis tries to identify the patients most at risk of PCF, methods of mitigating this risk and how best to treat a PCF. We also use our data to more generally look at airway interventions, swallowing difficulty and survival. We show that reducing the surgical insult need not be oncologically unsound and can reduce complications. Furthermore, we recommend the use of reconstructive flaps in high risk patients.