Background:Stomal recurrence that occasionally follows total laryngectomy is associated with very poor prognosis regardless of treatment modality, so it is very important to identify high risk patients to prevent stomal
recurrence.Objectives:We attempted to select an optimal management method to prevent stomal recurrence by analyzing risk factors in each patient who was found to have stomal recurrence following total laryngectomy.Materials and
Methods:Risk factors in each of eleven patients who had stomal recurrence out of 159 patients who underwent total laryngectomy in the last ten years were analyzed retrospectively. Data were gathered on risk factors such as the presence of
subglottic
extension, extralaryngeal extension, thyroid gland invasion, lymph node metastasis, timing of tracheotomy, tumor stage, postoperative radiotherapy, and inclusion of the stoma in the radiotherapy field.Results:There were eight cases of
subglottic
extension, six cases of extralaryngeal invasion, one case of pharyngocutaneous fistula that occurred as a postoperative complication, and one case who was taken completion laryngectomy following conservation surgery. With the exception of one
case
who
was taken tracheotomy prior to total laryngectomy, all tracheotomies were performed intra-operatively after endotracheal intubation. There was no evidence of paratracheal lymph node or prelaryngeal lymph node metastasis on preoperative neck CT
scan.
There were six cases of T4 tumors, four cases of T3 tumors, and one case of T2 tumor. Salvage surgery was performed following radiotherapy in three cases, and aside from one case who was not taken post-operative radiotherapy, postoperative
radiotherapy
including the stoma was performed in the remaining seven cases within one month after surgery.Conclusion:Total laryngectomy with wide paratracheal lymph node dissection, thyroidectomy, and tracheotomy should be performed for patients who
have
high risk factors such as subglottic extension and advanced stage. We believe that tracheotomy should be precede endotracheal intubation. Efforts should be made to prevent stomal recurrence by utilizing postoperative radiotherapy and by
minimizing
postoperative complications such as infection and fistula.
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