(0829) Primary and Salvage Total Laryngectomy: Influential Factors, Complications, and Survival

Introduction: In this retrospective study, we analyzed patients with advanced squamous cell carcinoma of the larynx and hypopharynx treated with total laryngectomy between 1990 and 2018.

Methods: The patients were treated by classical primary total laryngectomy (PTL), radiotherapy 60-70 Gy, concomitant radio and chemotherapy (cisplatin, 5 fluorouracil), or salvage total laryngectomy (STL). They were followed up for 5 years, and complications, survival rate, residual and recurrent disease and metastases were documented.

Results: Salvage total laryngectomy after previous radiotherapy (STL-pRT), and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than primary total laryngectomy (PTL). Disease free 5-year survival rate was significantly influenced by TNM stage and localization of the primary laryngeal tumor. For laryngeal cancer it was: 61.3% for PTL, 54.1% for STL-pCTRT, and 47.6% for STL-pRT. Incomplete responders to initial treatment had low survival rate. PTL for hypopharyngeal carcinoma and particularly salvage laryngectomy after chemoradiotherapy were associated with more frequent local complications. The overall survival for hypopharyngeal cancer was lower than for laryngeal cancer.

Conclusions: PTL still offers the best survival rate with low complications for advanced laryngeal and hypopharyngeal squamous cell carcinoma. STL causes more frequent local complications, especially after chemoradiotherapy. Addition of chemotherapy to radiotherapy increases the survival. Disease free 5-year survival rate depends on TNM stage and localization of the primary tumor.