Oncologic outcomes of total laryngectomy: Impact of margins and preoperative tracheostomy

BACKGROUND: The purpose of this present study was to investigate risk factors for local recurrence and death after total laryngectomy, with particular emphasis on pattern of local recurrence (stomal vs pharyngeal/base of tongue) and impact of preceding tracheostomy. METHODS: We conducted a retrospective review of 75 consecutive total laryngectomies for cancer of the larynx. RESULTS: Nineteen patients underwent preoperative tracheostomy, which was a significant risk factor for local recurrence (p = .04). With regard to pattern of local recurrence, preoperative tracheostomy (p = .03) and pathological nodal status (pN+; p = .04) were significant for stomal, but not pharyngeal recurrence; whereas positive margins (p = .01) was significant for pharyngeal, but not stomal recurrence. Preoperative tracheostomy, pN+, lymphovascular invasion, and positive margins were all significant for survival. CONCLUSION: Preoperative tracheostomy continues to be a significant adverse prognosticator in patients undergoing total laryngectomy. Our findings also suggest distinct causative factors for different patterns of postlaryngectomy local recurrence.