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Hypocalcemia after total laryngectomy

Incidence and Risk Factors

Authors

  • Naveed Basheeth MB, MRCSI,

    1. Department of Otolaryngology–Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
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  • Eadaoin O'Cathain MB, MRCSI,

    1. Department of Otolaryngology–Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
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  • Gerard O'Leary MB, FRCSI,

    1. Department of Otolaryngology–Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
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  • Patrick Sheahan MD, FRCSI (ORL-HNS)

    Corresponding author
    1. Department of Otolaryngology–Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
    • Send correspondence to Patrick Sheahan, Dept Otolaryngology–Head & Neck Surgery, South Infirmary Victoria University Hospital, Old Blackrock Rd., Cork, Ireland. E-mail: sheahan.patrick@sivuh.ie

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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Hypocalcemia is common in the initial period after total laryngectomy. The purpose of the present study was to study the incidence of and risk factors for postlaryngectomy hypocalcemia at our institution.

Study Design

Retrospective review of 65 consecutive total laryngectomies.

Methods

Clinical data and calcium levels for the first postoperative week were collected. Biochemical hypocalcemia was defined as any corrected calcium level of < 2.0 mmol/l in the first postoperative week. Severe hypocalcemia was defined as a calcium of < 1.8 mmol/l, or symptoms of hypocalcemia. Risk factors for hypocalcemia were studied.

Results

Five cases were excluded due to concomitant abdominal surgery (3), preoperative hypocalcemia (1), and no postoperative calcium levels (1). A total of 43% of patients had postoperative biochemical hypocalcemia. On univariate analysis, bilateral neck dissection was significant for hypocalcemia (P = 0.02), with pT4 classification having borderline significance (P = 0.07). On multivariate analysis, bilateral neck dissection (P = 0.02) and salvage surgery were significant (P = 0.03), with pT4 stage again having borderline significance (P = 0.05). Extent of thyroidectomy, extent of pharyngectomy, and preoperative tracheostomy were not significant. Fifteen patients (25%) had severe hypocalcemia. There were no significant risk factors for severe hypocalcemia identified.

Conclusions

Hypocalcemia is common after total laryngectomy, particularly in the postradiotherapy setting and in patients undergoing bilateral neck dissection. Preservation of one thyroid lobe does not appear to significantly reduce the risk.

Level of Evidence

4. Laryngoscope, 124:1128–1133, 2014

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