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Head and Neck Surgery

Effect of Primary Treatment of Laryngeal Malignancies on Swallow Outcomes

Tuesday, October 3, 2023
3:54 PM - 4:00 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Anna C. Lawrence, MD

    PGY4 Otolaryngology Resident
    University of Kansas Medical Center
    Mission, KS, United States

    • Co-Author(s)

  • OK

    Omar Karadaghy, MD

    University of Kansas Medical Center, USA

    • Senior Author(s)

  • SK

    Shannon Kraft, MD

    University of Kansas Medical Center, USA

    • Co-Author(s)

  • BR

    Bryan A. Renslo, MD

    Resident
    Thomas Jefferson University Hospital
    Philadelphia, PA, United States

  • Tuleen Sawaf, MD

    Resident
    University of Maryland Medical Center
    Baltimore, MD, United States

  • SK

    Sarah M. King, BS

    Medical Student
    University of Kansas Medical Center
    Prairie Village, KS, United States

Disclosure(s):
Anna C. Lawrence, MD: No relevant relationships to disclose.
Introduction: Advanced stage laryngeal squamous cell carcinoma (SCC) can be treated with primary surgery or chemoradiation (CRT). This study aims to determine if there are differences in post-operative swallow function in patients undergoing primary (PL) versus salvage laryngectomy (SL).

Methods: Retrospective cohort study of laryngectomies between 2011 and 2021. Demographic, diagnostic, treatment, and swallow function data were collected prior to and at 3-6 months following laryngectomy.

Results: One hundred twenty-six patients were included. Dysphagia was documented in 69.4% (62.5% PL vs 78.5% SL, p=0.121) of patients prior to laryngectomy. At 3-6 months post-op, 50% of patients demonstrated on going dysphagia. 37.1% still required a PEG. 14.6% were PEG free but were limited to a single consistency or required special preparation of food. 48.3% had resumed a total oral diet with minimal limitations. Average time of PEG utilization prior to removal was 7.86 months. There was no difference between groups regarding PEG dependence (p=0.77) or time to PEG removal (p=0.871)
Swallow function as determined by the Functional Oral Intake Scale (FOIS) improved following laryngectomy from a median score of 4 to 5 (p=0.0046). Improvement in the PL cohort was not significant. The SL group improved from a median of 2.0 to 5.0 (p=0.0110). Post-op FOIS scores were not different between the two groups (p=0.394).

Conclusions: Dysphagia is common among patients with advanced stage laryngeal SCCa. Patients undergoing SL appear to obtain similar swallow outcomes compared to PL at 3-6 months post-laryngectomy. Post-treatment, half of patients report on-going dysphagia, warranting further investigation.