Investigating the Incidence and Risk Factors of Hypocalcemia After Laryngectomy

Laryngeal cancer is a common advanced head and neck cancer. Surgery, radiation, chemotherapy, or a combination of these treatments are used to treat locally advanced laryngeal cancer. Total laryngectomy is generally preferred for T3-4 laryngeal cancers, despite being an invasive procedure. Post-surgical hypocalcemia is a known complication of neck compartment surgeries, and patients who have undergone laryngectomy are at a higher risk of developing hypoparathyroidism, leading to hypocalcemia. This study aims to investigate the prevalence and risk factors of hypocalcemia in individuals following laryngectomy.

This retrospective study examined 50 consecutive laryngectomy patients over eight years. Data on demographic characteristics, medical history, surgical details, pre-and post-operative calcium levels, neck dissection laterality, history of radiotherapy were collected. Hypocalcemia was defined as calcium levels < 8.5 mg/dl or corrected calcium < 8.5 mg/dl. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and binary logistic regression using R studio.

The mean age of participants was 59 years, predominating males (94%) and habitual smokers (94%). Squamous cell carcinoma was the most prevalent (98%) pathological diagnosis, and various surgical techniques were employed. While initial comparisons showed no significant changes in calcium levels pre-and post-operatively, adjusting for albumin levels revealed a significant association. Logistic regression identified neck dissection, low pre-operative calcium, radiotherapy, and total thyroidectomy as significant predictors of post-operative hypocalcemia (p < 0.05).

Surgical factors such as neck dissection and total thyroidectomy, alongside albumin levels, significantly impact postoperative hypocalcemia. These findings underscore the need for meticulous monitoring and potential preventive measures to manage calcium imbalance post-laryngectomy.