Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation: a 10-year retrospective longitudinal study in Eastern Denmark

OBJECTIVES: To determine the rates of and risk factors for postoperative complications following total laryngectomy in patients treated with radiotherapy or chemoradiation.

DESIGN: Retrospective longitudinal study.

SETTING: Tertiary medical centers.

PARTICIPANTS: 143 patients undergoing total laryngectomy for squamous cell carcinoma of the larynx or hypopharynx.

MAIN OUTCOME MEASURES: Overall postoperative complications and fistula formation.

RESULTS: Overall postoperative complications, fistula formation, wound infection, bleeding and wound necrosis within one year after total laryngectomy occurred in 56,6%, 42,3%, 31,0%, 11,3% and 9,2% of patients respectively. Stenosis of the pharynx/oesophagus and stoma shrinkage within five years after surgery were each seen in 18,2% of cases. In 66,7% of cases conservative treatment of the fistulas was chosen. Rehospitalizations within five years occurred for 44,8% with a median of 1,5 (range 1-11). Smoking status (p=0,005 and 0,013) and chronic obstructive pulmonary disease (COPD) (p=0,013 and 0,011) were significant risk factors for both overall postoperative complications and fistula formation in uni- and multivariate analysis. Tumor localization in the hypopharynx was associated with overall postoperative complications (p=0,036). Residual tumor or cancer recurrence was associated with late onset fistulas (p<0,001).

CONCLUSION: The frequencies of postoperative complications after total laryngectomy were comparable with similar international studies, although fistula formation rate is increasing in Denmark. We suggest optimizing treatment of COPD and to further encourage to smoking cessation. We propose that development of fistulas > 2 months after surgery prompt immediate biopsies. Additionally, we suggest standardised registration of surgical techniques to identify variables affecting the frequency of postoperative complications. This article is protected by copyright. All rights reserved.