Emergency Laryngectomy Feasibility and Indications Beyond Airway Obstruction in the Era of Concurrent Chemoradiotherapy.

BACKGROUND: It is believed that carrying out laryngectomy in tracheotomized patients leads to higher postoperative complications and stomal recurrence compared to carrying out the procedure upfront without prior tracheotomy. We believe that emergency laryngectomy is a feasible procedure in most cancer centers and can be carried out for indications beyond acute airway obstruction as well and complex reconstruction procedures can be also carried out simultaneously. We hereby describe our experience with emergency laryngectomy with or without pharyngectomy.

METHODS: Retrospective analysis of prospectively maintained data base was carried out. Patients who had undergone emergency laryngectomy in our department, from 2014 to 2018, were analyzed, and their clinicodemographic and histopathological features were noted. The indications for surgery and postoperative complications were charted down. Survival data of patients were also noted.

RESULTS: Seven patients have undergone emergency laryngectomy, 5 for acute airway obstruction and 2 for acute bleeding. Five patients were chemoradiotherapy failures, whereas 2 patients were operated upfront. Two out of 7 patients had pyriform fossa carcinoma, whereas rest of the patients had carcinoma of glottis. Reconstruction with pectoralis myocutaneous/pectoralis muscle only flap was carried out in 4 patients. Minor salivary leak was noted in 4 patients at varying time intervals from second week onward. Two patients had post radiotherapy chondroradionecrosis, without any residual/recurrent tumor. Three out of 7 patients developed recurrence which was salvageable in only 1 patient.

CONCLUSION: Emergency laryngectomy can be safely carried out in emergency setting in most cancer centers, more so over it can be carried out for indications beyond acute airway obstruction and combined with complex reconstruction procedures.