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Scientific Oral Presentations

Laryngology/Broncho-Esophagology

Session: Scientific Oral Presentations 1 - Laryngology/Broncho-Esophagology

Characterizing Pharyngeal Stenosis Following Total Laryngectomy: A Systematic Review and Meta-analysis

Saturday, September 28, 2024
9:54 AM – 10:00 AM EDT
Location: MBCC, 224
Disclosure(s):
Akash S. Halagur, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Amar H. Sheth, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Hisham Abdou, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Christina Hui Lee Ng, MBBS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Pharyngeal stenosis (PS) is a common sequela of total laryngectomy (TL), often leading to significant dysphagia. While stricture dilation procedures have shown efficacy in improving dysphagia, the heterogeneity in laryngectomy treatment contributes to a lack of uniform data. This systematic review aims to characterize PS as a sequela of TL, specifically incidence of dysphagia requiring dilation, and frequency/timing of dilation interventions.

Methods: A search of all studies from PUBMED published to January 2024 was conducted. Cohort studies reporting PS requiring dilation following TL (n>5) were included. Data was collected for: incidence, recurrence, median time from TL to dilation, TL indication, and reconstructive approach. Two evaluators independently performed study screening and data collection; all differences were resolved by a 3rd evaluator.

Results: In total, 11 studies met inclusion criteria. A total of 1,421 patients who underwent stricture dilation after TL were included, of which 659 (46.4%) were salvage, 286 (20.1%) sole primary treatment, and 153 (10.8%) primary with adjuvant treatment. 255 patients underwent reconstruction among which 86 (33.7%) had regional and 169 (66.3%) had free flaps. Mean age at TL was 64.1 (range 20-87) years with male-to-female ratio of 3.4:1. The overall incidence of dysphagia after TL requiring dilation was 21.8%. Of patients who required dilation, 69.4% required multiple. The median time to first dilation post-TL ranged from 9 to 24 months. Complication rate was 2.1%, including perforation, infection, and diminished tracheoesophageal voice quality.

Conclusions: Pharyngeal stenosis requiring dilation procedures is a significant morbidity in patients undergoing TL. More than 1 in 5 patients had pathologic stenosis requiring dilation after TL, of which 2 in 3 required repeat dilations. Major complications, though exceedingly rare, were predominantly observed during the first few dilation procedures. Given heterogeneity in treatment of laryngeal cancer, further research should delineate the contributions of adjuvant therapies and reconstruction approaches.

    Co-Author(s)

  • AH

    Akash S. Halagur, BS

    Medical Student | R25 Research Fellow
    Dartmouth & Stanford Otolaryngology–Head & Neck Surgery
    Framingham, MA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • SW

    Shannon Wu, MD

    Resident Physician
    Stanford Otolaryngology – Head & Neck Surgery, United States

    Disclosure information not submitted.

    • Presenting Author(s)

  • Amar H. Sheth, MD

    Resident Physician
    Stanford Otolaryngology-Head and Neck Surgery
    Palo Alto, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • HA

    Hisham Abdou, MD

    Resident
    Mayo Clinic Otolaryngology - Head and Neck Surgery
    Rochester, MN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • CN

    Christina Hui Lee Ng, MBBS

    Clinical Instructor
    Stanford University
    Menlo Park, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Edward J. Damrose, MD

    Professor
    Stanford University School of Medicine
    Stanford, CA, United States

    Disclosure information not submitted.