SALVAGE LARYNGECTOMY FOR UNSUCCESSFUL LARYNX PRESERVATION THERAPY

From 1983 to 1991, 31 patients underwent salvage laryngectomy for pers istent or recurrent squamous carcinoma of the larynx (14), hypopharynx (15), or oropharynx (2) as part of a larynx preservation protocol. La ryngectomy was performed as a consequence of poor response to inductio n chemotherapy in 13 and for recurrent disease after completion of che motherapy and irradiation in 18. Postoperative pharyngocutaneous fistu la occurred in 39%, resulting in prolonged hospitalization. Local cont rol was achieved in 68%, more often in patients with laryngeal as oppo sed to nonlaryngeal primaries (86% versus 53%; p = .05). The overall a ctuarial survival and disease-specific survival at 2 years were 32% an d 38%, respectively. Disease-specific survival at 2 years was better i n patients with laryngeal as compared to nonlaryngeal primaries (56% v ersus 24%; p = .02). There were no long-term survivors among the nonla ryngeal primary patients. In selected patients in whom larynx preserva tion failed, salvage laryngectomy was associated with acceptable local control and survival. Palliation was obtained in patients who were no t cured by their laryngectomy. Future investigation will focus on iden tification of factors predicting complications and strategies to reduc e the incidence and severity.