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The article discusses research which investigated the clinical course and risk factors leading to the formation of a pharyngocutaneous fistula (PCF) following total laryngectomy (TL) in patients with laryngeal cancer. Topics discussed include description of the study design, the performance of salvage TL due to failure RT or CRT in 59 patients and TL as the primary treatment in 43 patients, postoperative complications manifested by the patients and clinical applicability of the study.

Objectives Elective neck dissection during salvage laryngectomy is controversial. The goal of our study was to evaluate the effect of elective neck dissection during salvage laryngectomy in patients with locally advanced disease at recurrence. Design Multicentre, retrospective study. Settings Two tertiary medical centres. Participants Eighty-seven patients treated by salvage laryngectomy. Main outcome measures Disease-Free and Overall Survival. Results Fifty-seven patients underwent salvage total laryngectomy for locally advanced recurrent squamous cell carcinoma of the larynx, and 30 patients underwent salvage laryngectomy for limited recurrent disease. Elective lateral neck dissection was performed in 48 patients. The groups were similar in age, sex, initial TNM stage and pre-operative treatment. Survival analysis showed that both disease-free survival and overall survival were improved in patients with locally advanced disease who underwent elective neck dissection. This beneficial effect was not demonstrated in patients with limited disease at recurrence. Multivariate analysis showed that the extent of the recurrent disease as well as elective neck dissection was associated with improved disease-free survival and overall survival. Conclusions Elective neck dissection during salvage total laryngectomy seems to improve survival in patients with advanced local disease at recurrence. The role of neck dissection in the treatment of smaller tumours awaits further studies. [ABSTRACT FROM AUTHOR]

Clin. Otolaryngol. 2010, , 402-408 To investigate the prognostic significance of positive margin and disease course in partial laryngectomy for advanced laryngeal carcinoma and radiation failure. Retrospective case control study. A major tertiary referral centre. Patients who underwent partial laryngectomy for advanced laryngeal carcinoma or for radiation failure with at least 2 years of follow-up Margin status versus primary treatment and salvage treatment versus disease-free survival and overall survival. Twenty nine patients with sufficient follow-up data were found. Twelve patients had histological positive margin. Five of the 12 patients with a histological positive margin failed surgery as did four patients with clear margins. A positive margin had no effect on disease-free survival ( P = 0.287) but was associated with poorer overall survival ( P = 0.051). Of 11 patients treated primarily with surgery, recurrence was documented in one of eight with a positive margin and none of three with clear margins. Of 18 patients who underwent surgery secondary to radiation failure, recurrence was documented in all four with a positive margin and 4 of 14 with negative margins. Extended frontolateral resection, performed only in radiation failures, was associated with worse disease-free survival. Non-irradiated patients with involvement of a single margin after partial laryngectomy may be spared total laryngectomy if adjuvant radiation is administered. Patients who fail radiation should undergo radical partial laryngectomy, with conversion to total laryngectomy in those with a positive margin. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: During robot-assisted transaxillary thyroidectomy, the patient's arm is maintained in an overhead flexed position for a prolonged time, which poses a risk of postoperative brachial plexopathy. The aim of the study was to identify the causes of brachial plexopathy and to assess the benefit of intraoperative neurophysiological monitoring (IONM) in preventing positional brachial plexopathy in this setting., Study Design: Retrospective case series., Methods: The computerized database of a tertiary medical center was searched for all consecutive patients who underwent robot-assisted transaxillary thyroidectomy between 2012 and 2014. Clinical, operative, and outcome parameters were collected from the medical files. Findings were compared between patients operated with and without IONM., Results: The cohort included 30 patients, 14 operated with IONM and 16 without. Three events of impending brachial plexopathy were detected in the monitored group. The monitored group had significantly better shoulder movement (P = .003), a lower rate of hypoesthesia (P = .011), less pain (P = .001) in the early postoperative period than the nonmonitored group and higher quality of life in the early postoperative period (P = .012). The monitored group was significantly younger than the nonmonitored one (P = .02) and had a significantly larger diameter of thyroid nodule than the nonmonitored group (P = .043)., Conclusions: IONM during robot-assisted transaxillary thyroidectomy may improve short-term postoperative pain and shoulder movement and longer-term quality of life., Level of Evidence: 4 Laryngoscope, 126:2187-2193, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: To determine whether radial forearm free flap reconstruction of the tongue after partial glossectomy is associated with obstructive sleep apnea., Study Design: Retrospective case series., Methods: Fifteen patients (5 men, 10 women) treated for tongue cancer in 2006-2010 by partial glossectomy and immediate radial forearm free flap reconstruction completed the Epworth Sleepiness Scale and underwent polysomnographic studies. Background, clinical, and pathologic data were collected from the medical files., Results: Mean ± SD age of the study group was 57 ± 19 years; body mass index, 24 ± 4; follow-up, 5.6 ± 2.8 years. Mean ± SD Epworth scale score was 8.18 ± 6.18 (normal, <8). Disordered sleep was documented in 11 patients, of whom 8 (53.3% of the cohort) had OSA (5 mild, 2 moderate, 1 severe). The OSA rate was significantly higher than reported in the general population (P = 0.001)., Conclusion: Patients after partial glossectomy and radial forearm free flap reconstruction appear to be at high risk of obstructive sleep apnea. Testing for OSA should be considered in these patients., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: Elective neck dissection for the clinically negative neck is often a matter of debate. A decision-analysis model that was published in 1994 established the widely accepted principle that neck dissection is warranted when the risk for occult metastases is higher than 20%. The aim of the present study was to build a specific and up-to-date decision-analysis model to determine the need for elective neck dissection during salvage laryngectomy after chemoradiation failure and to identify the variables that effect the decision., Study Design: Decision-analysis model., Methods: A decision-analysis model was performed to compare the outcome of patients after salvage total laryngectomy with and without an elective neck dissection. Probabilities and expected utilities were derived from available literature to construct the model. Monte Carlo simulation and sensitivity analysis were used to calculate our models' outcomes and to identify the variables that influence the model most, respectively., Results: When calculating our model results with published data, we found that elective neck dissection is not warranted during salvage total laryngectomy. Optimal decision was found to be sensitive by two variables: 1) the probability for cure with neck dissection, and 2) the probability for regional-only recurrence after salvage laryngectomy without neck dissection. In multiway sensitivity analysis, only when cure rate with neck dissection exceeded 82%, adding neck dissection was the preferred decision. In practice, cure rates for patients after salvage total laryngectomy are around 50% to 65%., Conclusions: Based on our decision-analysis model, we do not recommend routine elective neck dissection during salvage total laryngectomy after failure of chemoradiation., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)