FACTORS INFLUENCING FUNCTIONAL OUTCOME IN SUPRAGLOTTIC LARYNGECTOMY

Background. The relationship between preoperative pulmonary function t ests (PFTs) and postoperative aspiration and deglutition complications in supraglottic laryngectomy (SL) has not been adequately analyzed. T he effects of numerous other variables are either controversial or hav e not been studied. Methods. A retrospective chart review was performe d on 46 SL patients, analyzing preoperative PFTs and arterial blood ga ses, demographic factors, stage of disease, extended resections, crico pharyngeal myotomy, hyoid preservation, neck dissection, and postopera tive radiotherapy with regards to aspiration and deglutition problems. Results. Eighteen (39%) patients had no problems, 15 (33%) had modera te 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 sh own to be independent from pack-years, whereas the converse was not cl early demonstrated. Extensions of the standard procedure did not corre late significantly with increased problems. Conclusions. An FEV1/FVC l ess than 50% signifies a greater risk for severe aspiration and deglut ition complications, although it must be regarded as one factor among many in determining operability. With careful attention to reconstruct ion, extensions of the standard SL procedure can be safely performed. (C) 1994 John Wiley & Sons, Inc.