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Functional Oral Intake in Primary Versus Salvage Laryngectomy
Anna C Lawrence1, Sarah King1, Bryan Renslo1
1Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA.
Summary
Patients undergoing salvage laryngectomy (SL) show similar oral intake to primary laryngectomy (PL) patients by 3-6 months, but PL patients continue to improve. Many patients experience long-term swallowing difficulties after laryngectomy.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Swallowing Disorders
Background:
- Advanced laryngeal squamous cell carcinoma is typically treated with primary surgery or chemoradiation.
- Functional oral intake is a critical outcome following laryngectomy.
Purpose of the Study:
- To compare postoperative functional oral intake between patients undergoing primary laryngectomy (PL) and salvage laryngectomy (SL).
Main Methods:
- Retrospective cohort study of 125 patients who underwent laryngectomy between 2011 and 2021.
- Analysis of demographic, diagnostic, treatment, and pre/postoperative swallow function data.
- Follow-up survey to assess long-term swallow status.
Main Results:
- Salvage laryngectomy (SL) patients had lower preoperative oral intake scores (FOIS) than primary laryngectomy (PL) patients, though not statistically significant.
- PL patients were more likely to have feeding tubes removed postoperatively.
- SL patients were more likely to require long-term feeding tube placement (>6 months).
- SL FOIS improved by 3 months post-surgery, while PL FOIS improved up to 12-15 months.
- 30.4% of patients reported ongoing dietary restrictions at a mean of 4.4 years post-surgery.
Conclusions:
- Swallow outcomes are similar between SL and PL patients at 3-6 months post-laryngectomy, but SL patients plateau.
- PL patients demonstrate continued improvement in oral intake up to one year.
- Fifty percent of all laryngectomy patients report persistent dysphagia five years after surgery.
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