Complications after total laryngectomy in nonradiated laryngeal and hypopharyngeal carcinomas

To study the complications of total laryngectomy, we evaluated 471 previous ly untreated patients who underwent total laryngectomy between 1980 and 199 7. This series consisted of 358 patients with primary carcinoma of the lary nx and 113 with carcinoma of the hypopharynx. Concurrent neck dissection wa s performed in 85% of patients. Complications were studied in relation to a ge, T and N stage, previous tracheostomy, neck dissection, margins, reconst ruction, tracheoesophageal puncture, and surgeon. Complication treatment an d hospitalization were also evaluated. The overall complication rate was 30 .7%, with 29.2% major and 6.5% minor complications. The mortality rate was 0.6% (3/471). Pharyngocutaneous fistula was the most frequent wound complic ation (21%), followed by wound infection (4.2%) and hemorrhage (2.3%). Pneu monia (1.4%) and embolism (0.4%) were the most frequent medical complicatio ns. Hypopharyngeal tumors, neck dissection, and extended procedures had a s ignificantly higher rate of complications. Complication causes, prevention, and treatment are discussed.