Oncologic outcomes of open conservation laryngectomy for radiorecurrent laryngeal carcinoma

A systematic review and meta-analysis of english-language literature

Authors

  • Vinidh Paleri MS, FRCS (Eng), FRCS (ORL-HNS),

    Corresponding author
    1. Department of Otolaryngology-Head and Neck Surgery, The Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
    • Consultant Surgeon and Honorary Clinical Senior Lecturer, Department of Otolaryngology-Head and Neck Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, United Kingdom

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    • Fax: (011) 44 01912231246

  • Ligy Thomas MS, FRCS (ORL-HNS),

    1. Department of Otolaryngology-Head and Neck Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
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  • Natesh Basavaiah MBBS, MRCS, DOHNS, DLO,

    1. Department of Otolaryngology-Head and Neck Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
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  • Mike Drinnan BEng, MEng, PhD,

    1. Department of Medical Physics, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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  • Hisham Mehanna BMedSc (Hons), MBChB (Hons), FRCS, FRCS (ORL-HNS),

    1. Department of Otolaryngology-Head and Neck Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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  • Terry Jones BSc (Hons), FRCS (ORL-HNS), MD

    1. Department of Otolaryngology-Head and Neck Surgery, Aintree University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
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Abstract

BACKGROUND:

The role of open conservation (partial) laryngeal surgery in radiorecurrent laryngeal cancers is unclear, and the procedure is not widely accepted or practiced. The objective of this review was to assess the oncologic and functional outcomes of partial laryngectomy in radiorecurrent tumors of the larynx reported in the literature.

METHODS:

The systematic review was performed using independently developed search strategies and included Medline, Embase, Zetoc, conference proceedings, and, when appropriate, a manual search. Inclusion criteria for the articles were set a priori. All included articles were subjected to quality assessment. Pooled estimates of local control at 24 months and of disease-free and overall survival rates were calculated using both a fixed-effects model (inverse square) and a random-effects model (DerSimonian-Laird).

RESULTS:

The search identified 401 publications, of which 26 studies satisfied all inclusion criteria. Ten studies had a quality score ≥6 (good), and 16 had a score of 4 or 5 (fair). The pooled estimates of oncologic outcomes using the random-effects model were as follows: The local control rate at 24 months for 560 patients was 86.9% (95% CI, 84%-89.5%), the disease-free survival rate for 352 patients was 91.2% (95% CI, 88.2%-93.9%), and the overall survival rate for 360 patients was 83.1% (95% CI, 79.1%-86.7%). Decannulation of tracheostomy occurred in 95.1% (95% CI, 92.6%-97.2%) of the patients who were analyzed (n = 315), whereas the pooled mean larynx preservation rate was 83.9% (95% CI, 80.7%-87%; n = 502)

CONCLUSIONS:

The current results indicated that open partial laryngectomies are oncologically sound procedures in the salvage setting and have a high larynx preservation rate. Cancer 2011. © 2011 American Cancer Society.

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