Laryngectomy is performed more often in patients with advanced laryngeal cancer

Zhu and colleagues recently investigated whether having a medical comorbidity influenced the choice of treatment of patients with advanced squamous cell carcinoma of the larynx. Comorbidity is the presence of an underlying pathologic condition that has an impact on a patient's total burden of disease. More than 2/3 of patients with cancer have a comorbid condition, and up to one-third of these patients have 2 or more, with hypertension, cardiovascular disease, and pulmonary disease among the most prevalent.

The study evaluated 16 849 patients from more than 1400 medical centers diagnosed with primary invasive advanced squamous cell carcinoma of the larynx between 2003 and 2008. They were selected from the National Cancer Database.

The study demonstrated that receipt of treatment (chemoradiation vs total laryngectomy) was significantly associated with comorbidity. Patients with comorbidity were more likely to have subtotal or total laryngectomy. Patients were also more likely to undergo laryngectomy if they had stage IV disease and if they had been diagnosed at a teaching or research institution. Patients were more likely to receive chemoradiation if they were diagnosed after 2003 or if they lived in a zip code with a high percentage of high school graduates.

The study is the first that demonstrates that patients with advanced laryngeal cancer with one or more comorbidities are more likely to receive surgery than chemoradiation compared with patients without any comorbidity. Previous studies have demonstrated better survival in patients with advanced laryngeal cancer who had been treated with surgery compared with those without.

This study supports the superiority of laryngectomy even in presence of comorbidity.  Even though patients with a comorbidity were less healthy initially their outcome was better after laryngectomy than those who received chemoradiation.

A new study illustrates the safety and efficacy of transoral robotic surgery for supraglottic laryngectomy

Transoral, minimally invasive organ preservation surgeries are being increasingly used for treatment of laryngopharyngeal carcinomas to avoid the toxicities of combined chemotherapy and radiation therapy regimens. A study by Ozer and colleagues from Ohio Medical Center in Columbus investigated the efficacy, safety, and functional outcomes of transoral tobotic surgery (TORS) supraglotic laryngectomy.
The preliminary study examined the outcomes of 13 of head and neck cancer patients with tumors located in the supraglottic region which is the region of the throat between the base of the tongue and just above the vocal cord. The study found that the use of robot-assisted surgery to remove these tumors through the mouth took only about 25 minutes on average, and that blood loss was minimal - a little more than three teaspoons, or 15.4 milliliters, on average, per patient. No surgical complications were encountered and 11 of the 13 patients could receive oral diet within 24 hours. If, on the other hand, these tumors are removed by performing open surgery on the neck, the operation can take at least 4 hours to perform, require 7 to 10 days of hospitalization on average and require a tracheostomy tube and a stomach tube.The results were published recently in the journal Head and Neck. According to the authors The transoral robotic method enables shorter surgery, less time under anesthesia, a lower risk of complications and shorter hospital stays for these patients and no external surgical incisions for the patient.

Transoral robotic surgery

Necrotizing fasciitis-a newly recognized complication of laryngectomy

Necrotizing fasciitis (NF) was recently recognized as a new post surgical complication of laryngectomy. NF is an unusual, life threatening, rapidly advancing serious infection characterized by widespread fascial and subcutaneous tissue necrosis and gangrene of the skin. It most commonly affects the extremities, abdominal wall and perineum, whereas cervical NF is rare. NF of the head and neck is often caused by both aerobic and anaerobic microorganisms found in the upper aerodigestive tract. Usually, cervical NF originates from odontogenic, tonsillar and pharyngeal infection, and it is very rarely a complication of surgical procedure. Without immediate surgical treatment, cervical NF leads to mediastinitis and fatal sepsis. There was only one case of cervical NF after total laryngectomy described in the literature. Hadzibegovic and colleagues recently reported two additional cases of cervical NF after total laryngectomy, selective neck dissection and primary vocal prosthesis insertion. In both cases, the infection spread to thoracic region and in one of the patients NF was associated with Lemierre's syndrome ( thrombosis of the internal jugular vein). In both patients, vocal prosthesis was inserted during the infection and did not influence the healing process.

CT scan of the neck demonstrates gas in the soft tissue of the left side of the neck associated with necrotizing fasciitis.