Stomal Recurrence after Total Laryngectomy

Objective: To evaluate the possible risk factors associated with recurrence of stomal recurrence after total laryngectomy that may be used as evidence of the efficacy of select preventive procedures. Methods: Various clinicopathologic factors of 548 patients who underwent total laryngectomy for laryngeal cancer at our hospital between January 1995 and December 2004 were reviewed. Univariate and multivariate logistic regression models were constructed to evaluate the risk factors for odds ratio (OR) and statistical significance. Results: Recurrence of stomal recurrence was observed in 48 cases and the median time to recurrence was 9.1 months. Univariate analysis showed that primary location (P = 0.000), T-stage (P = 0.000), preoperative tracheotomy (P = 0.001), and positive surgical margin (P = 0.000) were significant factors associated with stomal recurrence. Preoperative tracheotomy had no effect on the incidence of stomal recurrence in the T3 or T4 subgroups. Multivariate analysis showed that T-stage (OR = 1.687; P = 0.049), primary location (OR = 2.387; P = 0.012), and surgical margin (OR = 2.278; P = 0.020) were independent predictive factors for stomal recurrence. Conclusions: The prognosis of patients with stomal recurrence after laryngectomy is very poor. Identification of patients with high-risk factors is essential for offering more selective treatments to prevent their evolution.