Supracricoid laryngectomy for recurrent laryngeal cancer after chemoradiotherapy: a systematic review and meta-analysis

Residual or recurrent laryngeal cancer after irradiation is a difficult clinical problem with a rate that ranges from 13% to 36% of cases. Supracricoid laryngectomy (SCL) with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) provide reliable oncological and functional results for selected primary and recurrent patients with glottic and supraglottic carcinomas. We conducted a systematic review and meta-analysis to assess the oncological and functional outcomes of patients treated with open partial horizontal laryngectomy types IIa and IIb (CHEP, CHP) in terms of the recurrence of squamocellular cancer of the larynx after radiotherapy failure. The databases searched included MEDLINE, PubMed and EMBASE (from January 1990 to December 2015, English language). The meta-analysis was performed with a mixed random effects model using the DerSimonian and Laird method. The heterogeneity was measured with the I2 statistic. Fourteen papers out of 276 were included and comprised a total of 291 patients. The five-year overall survival was 80.2% (CI 0.719-0.885; I2 = 62%; p = 0.003), and the 5-year disease-free survival was 89.5% (CI 0.838-0.952; I2 = 52%; p = 0.022). The indications for SCL after the failure of radiation therapy (RT) were similar to those specified for previously untreated patients. We therefore hypothesised that careful assessment of tumour extension might be responsible for the high 5-year OS and 5-year DFS. The early postoperative recovery outcomes indicated that the mean time until decannulation was 35.6 days (CI 24.3-46.9; I2 = 95%; p < 0.001), and the mean time until nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) removal was 28.3 days (CI 22.7-33.8; I2 = 86%; p< = 0.001). These data are according to authors who prefer the initial removal of the NGT and the initiation of oral alimentation with a tracheostomy tube to protect and clean the airways and permit the suction of any residual food that might be present.