Quality of Life Outcomes in Salvage Laryngectomy Reconstruction

To evaluate functional oral intake and patient-reported dysphagia, neck disability, and symptom-specific health-related quality of life (HRQOL) amongst patients who underwent pectoralis major myocutaneous flap (PMMF) versus microvascular free flap reconstruction after salvage laryngectomy.

Retrospective analysis of prospectively collected data.

Multidisciplinary head and neck cancer (HNC) Survivorship clinic.

Patients with at least 6 months of postoperative follow-up from salvage total laryngectomy/total laryngectomy with partial pharyngectomy and subsequent PMMF or free flap reconstruction were included. Patients who underwent total laryngo-pharyngectomy, with recurrence, with metastatic disease, and/or with missing data were excluded.

Functional Oral Intake Scale (FOIS) and validated patient-reported outcome measures, including Eating Assessment Tool-10 (EAT-10), Neck Disability Index (NDI), and measures of pain-, swallowing-, and shoulder-specific University of Washington Quality of Life (UW-QOL) subscale scores.

Twenty-four patients underwent PMMF, and 30 patients underwent microvascular free flaps. Mean EAT-10, NDI, and pain-, swallowing-, and shoulder-specific UW-QOL subscale scores were not significantly different between these two groups. Mean FOIS was slightly higher in patients reconstructed with PMMF (5.67 ± 1.52 vs. 4.57 ± 2.12), p = 0.047, but the clinical relevance of this finding is unclear.

Patient-reported outcomes pertaining to dysphagia, neck disability, and pain-, swallowing- and shoulder-specific HRQOL did not vary significantly between patients reconstructed with PMMF versus microvascular free flap. Future studies with larger cohorts are required to further establish differences in functional outcomes between reconstructive approaches following salvage laryngectomy.