Is emergency laryngectomy a waste of time?

Patients who present with airway obstruction due to carcinoma of the larynx may be managed by tracheotomy followed by definitive tumor surgery at a later date. An alternative is emergency laryngectomy, defined as total laryngectomy performed within 24 hours, for a previously untreated and undiagnosed malignancy. In this study, we compare and contrast the outcome of 13 patients managed by tracheotomy and delayed laryngectomy to another group of patients, previously reported, managed by emergency laryngectomy.

Stridor due to malignant laryngeal neoplasm was treated by tracheotomy and delayed definitive laryngectomy in 13 patients. In every case, the tracheostomy site was removed with a surgical specimen. A comparison of the survival data was performed with earlier reported series of 13 emergency laryngectomies using the Wilcoxon log rank method.

All patients were followed for a minimum of 24 months. Seven patients underwent postoperative radiotherapy. Two of these patients (15%) developed peristomal recurrence at 6 and 22 months respectively. Both died of disease. Six patients from each group survived disease free for a minimum of 24 months. No significant correlation was found between the time delay of definitive surgery and survival (P > .5).

This series suggests that emergency laryngectomy offers patients no survival advantage. Emergency laryngectomy does, however, have several disadvantages. These include the necessity to rely on frozen section analysis, the difficulty in obtaining expert anesthetic support, and the inability to provide thorough and complete nutritional and metabolic work up before major surgery. Finally, the psychologic aspects of radical surgery for patient and family cannot be adequately addressed. We conclude that stomal recurrence is as much a function of extensive disease at presentation as of preliminary tracheotomy. Emergency laryngectomy is not a superior treatment modality and offers no particular survival advantage.