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Laryngology/Broncho-Esophagology

(526) Upfront Tracheostomy for T4 Laryngeal Cancer Associated with Increased Mortality

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • EE

    Evan R. Edwards, MME

    Medical Student
    Feinberg School of Medicine
    Chicago, Illinois, United States

    • Co-Author(s)

  • JH

    Jared Hara, MD

    University of Chicago Medicine, USA

  • AJ

    Aditya Juloori, MD

    University of Chicago Medicine, USA

    • Senior Author(s)

  • Brandon J. Baird, MD

    Assistant Professor
    Section of Otolaryngology-Head & Neck Surgery, The University of Chicago
    Chicago, Illinois, United States

Disclosure(s):
Evan R. Edwards, MME: No relevant relationships to disclose.
Brandon J. Baird, MD: No relevant relationships to disclose.


Introduction: Tracheostomy is frequently performed to create a safe airway for T4 laryngeal cancer (LSCC) patients. This study assessed survival outcomes of patients pursuing organ preservation therapy with definitive chemoradiation (CRT) based on their initial airway strategy at time of diagnosis.

Methods: Patients with T4 LSCC receiving definitive CRT at the University of Chicago were identified from January 1990 to December 2019. Clinicodemographic characteristics (age at diagnosis, sex, race, and 10-year diagnosis period, clinical trial enrollment) were compared using t-tests and X2. The Kaplan-Meier method was used to estimate 5-year Overall Survival (OS) and Laryngectomy Free Survival (LFS) after upfront tracheostomy or endoscopic debulking. Multivariable Cox proportional hazards were modeled for survival outcomes to report adjusted hazard ratios (aHR).

Results: Of 93 patients, 65% were male, mean age was 61 years, and median follow up was 53 months. Upfront tracheostomy occurred in 52% of patients vs. 28% receiving debulking. Black patients underwent upfront tracheostomy more often than white patients (65% vs 42% p = 0.03), otherwise characteristics were similar between groups. Of patients who received an upfront tracheostomy, 83% were performed awake. The 5-year OS and LFS rates were 53% and 50% for upfront tracheostomy and 92% and 88% for endoscopic debulking, respectively. Further, covariate-adjusted analysis showed that tracheostomy was associated with decreased LFS (aHR=2.0[1.0-3.8] p= 0.04) overall and decreased OS (aHR=5.2[1.6-17.2], p= 0.006) during the modern era (2010-19). Endoscopic debulking was associated with improved OS (aHR=0.37[0.17-0.82] p= 0.01) and LFS (aHR=0.39[0.18-0.85], p= 0.018) over the entire study period.

Conclusions: Upfront awake tracheostomy has been used to secure the airway in patients with T4 LSCC for decades, regardless of definitive treatment approach. This study demonstrates a significant decrease in survival, particularly in the modern era, for patients that undergo upfront tracheostomy and improved survival in patients that are debulked at the time of diagnosis.