Stomal recurrence after total laryngectomy: clinical and patological analysis of risk factors

Year 2009, Volume: 19 Issue: 3, 146 - 150, 08.06.2009

Sedat Öztürkcan Çağlar Çallı Rıza Dündar Bilge Tuna Hüseyin Katılmış Hale Aslan Ali Ekber İlknur Mehmet Sinan Başoğlu Mehmet Ali Tayfun

Abstract

Objectives: The aim of this study is to evaluate risk factors for stomal recurrence and to state and emphasize the importance of these factors. Patients and Methods: This study was carried out retrospectively on 119 patients 116 males, 3 females; mean age 56.8 years; range 31 to 86 years with larynx cancer who underwent total laryngectomy. All patients were examined for T-stage and location of primary tumor, tracheotomy preoperative or postoperative opening time, modality of applied treatment, presence of pharyngeal stoma fistula and presence of cervical lymph node metastasis in the postoperative period. Results: Five patients 4.2% out of 119 had stomal recurrence. Development period of stomal recurrence after laryngectomy was found to be between six months and three years mean: 16.6 months . Conclusion: The treatment of this fatal complication is very difficult, and it has a poor prognostic nature. As a result, presence of subglottic involvement and advanced tumors in our cases are considered as main risk factors.

Keywords

Laryngeal cancer/pathology, laryngectomy, stomal recurrence

Total larenjektomi sonrası stomal nüks: Risk faktörlerinin klinik ve patolojik analizi

Abstract

Amaç: Stomal nüksün risk faktörleri değerlendirildi ve bu faktörlerin önemi vurgulanarak ortaya kondu.Hastalar ve Yöntemler: Bu çalışma, geriye dönük olarak, total larenjektomi yapılan 119 larenks kanserli hasta 116 erkek, 3 kadın; ort. yaş 56.8 yıl; dağılım 31-86 yıl ile yapıldı. Tüm hastalar primer tümörün T evresine, tümörün bulunduğu yerleşim yerine, trakeotominin ameliyat öncesi veya sonrası açılma zamanına, uygulanan tedavi modalitesine, ameliyat sonrası dönemde farengokütanöz fistül varlığı ve servikal lenf nodu yayılım varlığına göre değerlendirildi.Bulgular: Yüz on dokuz hastanın beşinde %4.2 stomal nüks gelişti. Stomal nüks gelişimi total larenjektomi sonrası altı ay ile üç yıl arasında ort. 16.6 ay oluştu.Sonuç: Bu ölümcül komplikasyonun tedavisi zor olmakla birlikte, prognozu da iyi değildir. Yaptığımız çalışma sonucunda subglottik tutulum varlığı ve tümörün ileri evreli olması başlıca risk faktörleri olarak değerlendirildi

Keywords

Larenks kanseri/patoloji, larenjektomi, stomal nüks

References

• Zbären P, Greiner R, Kengelbacher M. Stoma recur- rence after laryngectomy: an analysis of risk factors. Otolaryngol Head Neck Surg 1996;114:569-75.
• Rubin J, Johnson JT, Myers EN. Stomal recurrence after laryngectomy: interrelated risk factor study. Otolaryngol Head Neck Surg 1990;103:805-12.
• Breneman JC, Bradshaw A, Gluckman J, Aron BS. Prevention of stomal recurrence in patients requiring emergency tracheostomy for advanced laryngeal and pharyngeal tumors. Cancer 1988;62:802-5.
• Hosal IN, Onerci M, Turan E. Peristomal recurrence. Am J Otolaryngol 1993;14:206-8.
• Mantravadi R, Katz AM, Skolnik EM, Becker S, Freehling DJ, Friedman M. Stomal recurrence. A critical analysis of risk factors. Arch Otolaryngol 1981; 107:735-8.
• Weber RS, Marvel J, Smith P, Hankins P, Wolf P, Goepfert H. Paratracheal lymph node dissection for carcinoma of the larynx, hypopharynx, and cervical esophagus. Otolaryngol Head Neck Surg 1993;108:11-7.
• Bignardi L, Gavioli C, Staffieri A. Tracheostomal recur- rences after laryngectomy. Arch Otorhinolaryngol 1983;238:107-13.
• Barr GD, Robertson AG, Liu KC. Stomal recurrence: a separate entity? J Surg Oncol 1990;44:176-9.
• Halfpenny W, McGurk M. Stomal recurrence follow- ing temporary tracheostomy. J Laryngol Otol 2001; 115:202-4.
• Fagan JJ, Loock JW. Tracheostomy and peristomal recurrence. Clin Otolaryngol Allied Sci 1996;21:328-30.
• Medina JE, Khafif A. Early oral feeding following total laryngectomy. Laryngoscope 2001;111:368-72.
• Natvig K, Boysen M, Tausjİ J. Fistulae following laryngectomy in patients treated with irradiation. J Laryngol Otol 1993;107:1136-9.
• Tosun F, Gerek M, Birkent H, Özkaptan Y. Total lar- enjektomi sonrası farengokutanöz fistül; değişik risk faktörlerinin analizi. Türkiye Klinikleri J E.N.T. 2002; 2:133-9.
• Markou KD, Vlachtsis KC, Nikolaou AC, Petridis DG, Kouloulas AI, Daniilidis IC. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence? Eur Arch Otorhinolaryngol 2004;261:61-77.