Salvage surgery after unsuccessful radiotherapy of cancer of the larynx

The problem of the surgical management of irradiation failures in laryngeal carcinoma is taken into consideration. A series of 60 consecutive laryngectomies performed at the E.N.T. Department of the Regional Hospital of Varese from 1982-1987 is presented. All patients had previously undergone curative radiotherapy for squamous cell carcinoma of the larynx with subsequent local recurrence. The postoperative course is examined in relation to the observed 11 cases of complications (18.3%) taking them into consideration individually. A statistical analysis is also presented for the incidence of complications in relation to the most significant parameters. No significant difference was found in regard to timer elapsed since termination of radiotherapy (more or less than 6 months), irradiation field extension (limited to the larynx or extended to the neck nodes), type of surgical salvage (including neck dissection or not) and pre-operative hemoglobin and blood proteins values. In those patients who had previously undergone irradiation, total laryngectomy is quite a safe procedure in terms of potential local-regional complications. The choice of primary radiotherapy should not be influenced by the fear of such complications arising if salvage surgery is required after local recurrence