Outcome of Total Laryngectomy (One Centre Experience)

Objectives: To assess the patients with advanced carcinoma of the larynx and its sequelae post–total laryngectomy. Patients and method: The study was conducted as a prospective study including patients who had undergone total laryngectomy for histologically proven laryngeal cancer at Medical City Complex, Surgical Specialties Hospital, Department of Otolaryngology and Head & Neck Surgery, from January 1st, 2011, to December 31st, 2013. A total of 39 patients were included in the study.Patients excluded from the study were those who had undergone neck dissection, total pharyngolaryngectomy, or partial laryngectomy. Local and general complications were noted along with the possible affecting factors. Outcomes were documented, and statistical analysis was performed using simple percentages and frequencies. Results: A total of 39 patients underwent total laryngectomy over a period of three years and were followed for three years. The male-to-female ratio was 3.875:1. The mean age was 56 years, ranging from 40 to 75 years. Smokers constituted 87.5% of the patients. Salvage laryngectomy was performed in 17.9% of cases. Histological findings were as follows: 25 (64%) well-differentiated carcinomas, 1 verrucous carcinoma, 11 (28.2%) moderately differentiated carcinomas, and 3 (7.69%) poorly differentiated carcinomas. Early complications included pharyngocutaneous fistula in 11 (36.5%) patients and wound infection in 5 (12.5%) patients. None of the patients developed superficial wound necrosis or wound hematoma. Two patients passed away perioperatively due to cardiac problems confirmed by ECG. One patient developed a myocardial infarction on the 7th postoperative day and was admitted to the CCU. Subclinical hypocalcaemia was noted in 5 patients, detected through routine postoperative electrolyte monitoring. Conclusion and recommendations: Total laryngectomy plays a major role in the management of laryngeal carcinoma. Pharyngocutaneous fistula was the most common early postoperative complication. Recognition of the risk factors for complications is essential to prevent them.