Abstract
Objective: 1) To analyze postoperative clinical outcomes in patients after total laryngectomy (TL). 2) To identify factors that may affect long-term survival. 3) To evaluate the computed tomography (CT) scan’s value in the study of laryngeal and hypopharyngeal cancer.
Method: We performed a retrospective cohort study of patients who underwent TL for cancer between January 1, 2000, and December 31, 2004, at Instituto Português de Oncologia, Lisbon. Baseline characteristics, pretreatment clinical variables, and follow-up data were collected from medical records.
Results: Three hundred seventy-eight patients underwent TL. Most of the cancers were in advanced stage (IVa or higher), and arising at the larynx (71%). CT scan correctly evaluated the T stage only in 35%. The patients were primarily treated with surgery and adjuvant radiotherapy in 86%. The overall 5-year survival rate and the 5-year disease-specific survival rate were 31% and 38%, respectively. The overall locoregional control was 66% and the overall recurrence rate was 55% (39% distant metastasis). Factors identified as related to long-term survival: Cancer site in the larynx, T3 stage, N0-N1 stage, and no more than 2 comorbidities.
Conclusion: Most of our patients had advanced tumors, which compromised survival. Other clinical variables (tumor site, comorbidities) may affect survival and treatment options. Those are often decided based on tumor evaluation by CT scan, which showed limited value. Public health education, earlier referral, and attention in treatment selection should be held.
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