Data from 130 patients who underwent total
laryngectomy for
squamous cell carcinoma of the larynx were reviewed. Patients were treated either by primary
laryngectomy and planned postoperative
radiotherapy or by primary
radiotherapy and subsequent salvage
laryngectomy. Patients with other treatment modalities and patients with positive margins of resection and
laryngectomies for
hypopharyngeal cancers were excluded from the study. The stomal recurrence rate with reference to several risk factors, such as primary
tumor stage, location of
tumor,
lymph node metastases, timing of
tracheotomy, and presence of a postoperative pharyngoperistomal
fistula, was analyzed. The overall incidence of stomal recurrence was 10%. The treatment modality appeared to have an impact on subsequent stomal recurrence: stomal recurrence developed more often after salvage
laryngectomy (18.4%) than after primary
laryngectomy with planned postoperative radiation (4.8%). Advanced T stage, N stage, subglottic involvement, and preoperative
tracheotomy are risk factors for stomal recurrence only in patients with a primary
laryngectomy. Stomal recurrence developed in only four patients after primary
laryngectomy with planned radiation. All four patients had more than one risk factor: primary
tumor stage T4 (four times), subglottic involvement (three times), and preoperative
tracheotomy (three times). The presence of a postoperative pharyngoperistomal
fistula likewise may represent a risk factor for the development of a stomal recurrence.