Peristomal recurrence.

INTRODUCTION

Peristomal recurrence following laryngectomy is a very serious and fatal complication. To treat this complication, extensive surgical resection has been advocated. However, when peristomal recurrence develops, the prognosis is dismal and the mortality is nearly 100%. Therefore, attention should focus on prevention.

METHODS

Treatment of patients with tumors of the subglottis should include attention to the paratracheal region and superior mediastinum. For this reason pretracheal, paratracheal, and retrosternal dissection has been performed in patients with subglottic lesions since 1968 in the Otolaryngology Department of the Hacettepe Faculty of Medicine.

RESULTS

The incidence of peristomal recurrence was 11.5% before 1968 in patients without pretracheal, paratracheal, and retrosternal dissection. The incidence of peristomal recurrence dropped from 11.5% to 2.7% after routine application of pretracheal, paratracheal, and mediastinal dissection in patients with subglottic lesions (either primarily or secondarily).

DISCUSSION: A total of 488 patients with total laryngectomy were studied. The importance of pretracheal, paratracheal, and retrosternal dissection in patients with subglottic carcinoma of larynx (primarily or secondarily) was emphasized.