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Adjuvant Radiotherapy and Local Control After Total Laryngectomy With Preoperative Tracheotomy: A Systematic Review

Daniel Uralov¹, Gian Marco Pace^2,3, Luca Canali²

¹Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|May 4, 2026

Summary

Patients undergoing total laryngectomy (TL) with preoperative tracheotomy face higher recurrence risks. Postoperative radiotherapy (PORT) may significantly reduce these local/peristomal recurrence rates in this patient group.

Keywords:

cancer of the head and neck laryngeal neoplasms local neoplasm Recurrence peristomal recurrence squamous cell carcinoma of head and neck

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Area of Science:

Otolaryngology
Head and Neck Surgery
Oncology

Background:

Total laryngectomy (TL) is a standard treatment for advanced laryngeal cancer.
Preoperative tracheotomy in TL patients is associated with increased local/peristomal recurrence.
The role of postoperative radiotherapy (PORT) in mitigating this risk is not fully established.

Purpose of the Study:

To evaluate the impact of PORT on local and peristomal recurrence in patients undergoing primary TL with a preoperative tracheotomy.
To quantify the recurrence risk associated with preoperative tracheotomy in TL patients.
To determine if PORT can reduce recurrence rates in TL patients with preoperative tracheotomy.

Main Methods:

Systematic literature search of PubMed, Scopus, and Google Scholar.
Single-arm meta-analysis of proportions to estimate pooled recurrence rates.
Inverse variance method used for calculating effect sizes and 95% confidence intervals (CIs).

Main Results:

A total of 4339 patients were included in the meta-analysis.
Preoperative tracheotomy was present in 20.3% of patients.
Local/peristomal recurrence rates were 7.0% without tracheotomy vs. 17.9% with tracheotomy.
In patients with tracheotomy, PORT reduced recurrence from 34.8% to 12.5%.

Conclusions:

Preoperative tracheotomy significantly increases local/peristomal recurrence risk after primary TL.
PORT demonstrates a potential benefit in reducing recurrence rates for TL patients with preoperative tracheotomy.
PORT should be considered for patients undergoing TL with a preoperative tracheotomy to mitigate recurrence risk.