Predictors of Stricture and Swallowing Function Following Salvage Laryngectomy

Background Long‐term functional outcomes are poorly characterized for salvage laryngectomy. We identified predictors of esophageal stricture and swallowing function after salvage laryngectomy in a large cohort. Methods A retrospective study of 233 patients who underwent salvage total laryngectomy for recurrent/persistent squamous cell carcinoma of the larynx or hypopharynx after radiation (XRT) or chemoradiation (CRT) was performed. Primary outcomes were esophageal dilation within 1 year, time to dilation, and gastrostomy tube dependence. Multivariate logistic and Cox regressions were used for statistical analysis. Results Dilation was performed in 29.9% of patients. Dilation was twice as likely in patients with post‐operative fistula compared to those without (Hazard Ratio (HR) 2.10, 95% Confidence Interval (CI) 1.06–4.13, P = .03). Every year between XRT/CRT and salvage was associated with 10% increase in dilation (HR 1.09, 95% CI 1.03–1.17, P = .01). No factors were associated with dilation by 1 year. About 10% of patients were at least partially gastrostomy tube‐dependent 1 year post‐operatively. At last follow‐up (median 29 months), this rate was 13%. Patients with supraglottic recurrence had an increased risk of gastrostomy tube dependence at 1 year compared to glottic (OR 16.7, 95% CI 1.73–160, P = .02). For every 10 pack years pre‐salvage, the OR of requiring tube feeds at last follow‐up was 1.24 (95% CI 1.04–1.48, P = .02). Conclusions Fistula and pre‐salvage smoking were associated with stricture post‐salvage laryngectomy. No factors were associated with dilation by 1 year. Supraglottic recurrence and smoking were associated with gastrostomy tube dependence. These findings are important for pre‐operative counseling prior to salvage laryngectomy. Level of Evidence Level 4 Laryngoscope, 131:1229–1234, 2021