Challenges in the Management of Laryngeal Stenosis After Partial Laryngectomy for Laryngeal Squamous Cell Carcinoma.

Abstract

Laryngeal stenosis is a significant complication impairing quality of life after partial laryngectomy for laryngeal squamous cell carcinoma (LSCC). This study aimed to evaluate the efficacy of different management strategies (endoscopic vs. open). We conducted a retrospective cohort study who developed laryngeal stenosis following partial laryngectomy for LSCC between December 2011 and December 2023. Patient demographics, etiological factors, and therapeutic interventions were systematically analyzed to evaluate clinical outcomes and summarize management experience. The study cohort comprised 61 patients (4 females, 57 males) aged 25-77 years old. The overall decannulation rate was 52.5% (32/61). Endoscopic treatments included laser, balloon dilation and laser combined with balloon dilation, with a decannulation rate of 64.71%, 33.3%, and 45.45%, respectively. Of the 45 patients who received a single endoscopic treatment, successful decannulation was achieved in 25 cases (55.6%), while among the 11 patients that received multiple endoscopic treatment, only 3 (27.3%) patients attained successful decannulation. In contrast, open laryngotracheal reconstruction (LTR) with T-tube placement showed superior outcomes, with an 80% (4/5) decannulation rate. Among the 61 patients with laryngeal stenosis, those who underwent endoscopic treatment did not require postoperative nasogastric feeding, and their postoperative hospital stay was significantly shorter compared to those who underwent LTR with T-tube. Laser-assisted endoscopic techniques is recommended as the initial treatment for laryngeal stenosis following partial laryngectomy due to its minimally invasive nature and faster recovery. However, for patients who fail initial endoscopic treatment, LTR with T-tube is often recommended due to its higher decannulation rate, rather than repeated endoscopic attempts.