Factors influencing functional outcome in supraglottic laryngectomy

BACKGROUND: The relationship between preoperative pulmonary function tests (PFTs) and postoperative aspiration and deglutition complications in supraglottic laryngectomy (SL) has not been adequately analyzed. The effects of numerous other variables are either controversial or have not been studied. METHODS: A retrospective chart review was performed on 46 SL patients, analyzing preoperative PFTs and arterial blood gases, demographic factors, stage of disease, extended resections, cricopharyngeal myotomy, hyoid preservation, neck dissection, and postoperative radiotherapy with regards to aspiration and deglutition problems. RESULTS: Eighteen (39%) patients had no problems, 15 (33%) had moderate problems, and 13 (28%) had severe problems; of these, 39 (85%) were ultimately successful with no further swallowing dysfunction, whereas seven (15%) suffered intractable aspiration difficulties. Decreasing FEV1/FVC was significantly correlated with a poorer outcome, as was a greater number of pack-years of smoking. The effect of FEV1/FVC was shown to be independent from pack-years, whereas the converse was not clearly demonstrated. Extensions of the standard procedure did not correlate significantly with increased problems. CONCLUSIONS: An FEV1/FVC less than 50% signifies a greater risk for severe aspiration and deglutition complications, although it must be regarded as one factor among many in determining operability. With careful attention to reconstruction, extensions of the standard SL procedure can be safely performed.