Adjuvant Radiotherapy and Local Control After Total Laryngectomy With Preoperative Tracheotomy: A Systematic Review and Meta-Analysis.

Abstract

To evaluate the impact of postoperative radiotherapy (PORT) on local and peristomal recurrence in patients undergoing primary total laryngectomy (TL) with a preoperative tracheotomy. A systematic search of PubMed, Scopus, and Google Scholar was conducted. A single-arm meta-analysis of proportions was performed to estimate pooled local/peristomal recurrence rates. The inverse variance method was used to calculate effect sizes and 95% confidence intervals (CIs). A total of 4339 patients undergoing primary TL without preoperative radiation therapy were included. Preoperative tracheotomy was performed in 879/4339 (20.3%) cases. The pooled local/peristomal recurrence rate was 7.0% (95% CI: 5.3-9.2) in patients without preoperative tracheotomy and 17.9% (95% CI: 12.8-24.6) in those with tracheotomy. Among patients with preoperative tracheotomy, those who received PORT had a lower recurrence rate of 12.5% (95% CI: 7.8-19.5) compared to 34.8% (95% CI: 16.4-59.2) in those who did not receive PORT. Preoperative tracheotomy is associated with a markedly increased risk of local/peristomal recurrence following primary TL. Our findings suggest that PORT may reduce this risk and can be considered in patients undergoing TL with a preoperative tracheotomy.