Risk factors for dysphagia following total laryngectomy

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BACKGROUND: Dysphagia is a common and challenging long-term sequela following total laryngectomy (TL) that can negatively impact patient quality of life. Following TL, many patients require repeat esophageal dilations to maintain swallowing function. This study aimed to identify surgical and non-surgical risk factors associated with dysphagia following TL, defined as clinically diagnosed postoperative dysphagia based on patient-reported symptoms and dysphagia requiring dilation. METHODS: We conducted a retrospective single-institution cohort study of patients who underwent total laryngectomy from 1999 to 2024. Outcomes included clinically diagnosed dysphagia and dysphagia requiring esophageal dilations, with covariates including age, BMI, preoperative PEG tube, cricomyotomy, flap reconstruction type, pharyngectomy, glossectomy, base of tongue resection, postoperative complication, neoadjuvant radiation, and adjuvant radiation. Associations between dysphagia and covariates were assessed using univariable and multivariable logistic regressions. RESULTS: A total of 787 patients underwent total laryngectomy. Median follow-up was 28.5 months (Interquartile range [IQR]: 10.3-68.2 months). During the follow-up period, 212 patients (26.9 %) reported dysphagia, and 131 patients underwent dilation (16.6 %). Prior radiation (adjusted odds ratio [aOR]: 2.51, 95 % CI: 1.56-4.05, p < 0.001), adjuvant radiation (aOR: 1.86; 95 % CI 1.10 to 3.17; p = 0.021), and tongue base resection (aOR: 2.14, 95 % CI: 1.24-3.70, p = 0.006) were independently associated with postoperative clinical dysphagia. Total pharyngectomy (odds ratio [OR]: 1.83, 95 % CI 1.17-2.83, p = 0.008) was associated with dysphagia on univariable analysis. Pedicled reconstruction (OR: 1.38, 95 % CI 1.00-1.90, p = 0.053) showed a trend towards increased odds of clinical dysphagia. Only prior radiation was independently associated with dysphagia requiring esophageal dilation (aOR: 2.92, 95 % CI: 1.62-5.26, p < 0.001). CONCLUSIONS: Dysphagia is common following total laryngectomy. Prior radiation, adjuvant radiation, total pharyngectomy, tongue base resection, and pedicled reconstruction were factors influencing swallowing outcomes following TL. Salvage TL patients should be counseled on the possible need for post-laryngectomy esophageal dilations.

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