Prevention of stomal recurrence.

Abstract

The authors reviewed the incidence of stomal recurrence (SR) in a population of laryngectomized patients to study associated risk factors and determine the usefulness of certain preventive procedures. A retrospective study was performed in 296 patients with larynx and hypopharynx carcinoma treated by total laryngectomy. Of the 296 patients, 6 (2%) were initially seen with SR. In all cases, a risk factor was found to be involved: subglottic extension (5 cases), tracheotomy prior to laryngectomy (1 case). Since 1989, when preventive measures were systematically introduced in patients presenting risk factors, there have been no further cases of SR. The surgical measures in tumors with subglottic extension consisted of hemithyroidectomies, paratracheal lymph node dissection, and extensive tracheal resection; in the case of a tracheotomy prior to the laryngectomy, extensive resections of the tracheal stoma were carried out. The systematic use of preventive surgical measures together with postoperative radiotherapy to the stoma and superior mediastinum have led to a decrease in the appearance of SR.