Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

Gallo, O.; Deganello, A.; Gitti, G.; Santoro, R.; Senesi, M.; Scala, J.; Boddi, V.; De Campora, E.

doi:10.1016/j.oraloncology.2008.03.013

« Previous Next »Oral Oncology
Volume 45, Issue 1 , Pages 30-38, January 2009

Prognostic role of pneumonia in supracricoid and supraglottic laryngectomies

O. Gallo
- Department of Otolaryngology Head and Neck Surgery, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
- Corresponding author. Tel.: +39 0 55411772; fax: +39 0 55435649.
- These authors equally contributed to the study.
A. Deganello
- Department of Otolaryngology Head and Neck Surgery, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
- These authors equally contributed to the study.
G. Gitti
- Department of Otolaryngology Head and Neck Surgery, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
R. Santoro
- Department of Otolaryngology Head and Neck Surgery, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
M. Senesi
- Department of Otolaryngology Head and Neck Surgery, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
J. Scala
- Department of Otolaryngology Head and Neck Surgery, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
V. Boddi
- Department of Public Health, Statistical Division, University of Florence, Viale Morgagni 48, 50134 Florence, Italy
E. De Campora
- Department of Otolaryngology Head and Neck Surgery, University of Florence, Viale Morgagni 85, 50134 Florence, Italy

Received 31 January 2008; received in revised form 12 March 2008; accepted 14 March 2008. published online 14 July 2008.

Summary

The goal of this study was to identify host and tumour factors associated with postoperative pneumonia (PP) in a selected population of laryngeal cancer patients, treated by partial laryngectomy in 20 years at our Institution and to assess its potential prognostic impact.

Clinical records of 416 consecutive patients were retrospectively reviewed. Tobacco consumption, body mass index (BMI), previous pulmonary disease, age, sex, preoperative blood gas analysis values, tumour stage and type of surgery were tested as potential risk factors for PP. Finally, the prognostic impact of these variables, including PP, in terms of disease-free and actuarial survival by Kaplan–Meier and Cox analyses were evaluated.

PP developed in 73 patients (16.8%). We identified two groups of patients: 26 patients experienced an early PP within the first 7–9 days after surgery, whilst 44 experienced an ab ingestis PP following attempts of oral food intake restoration, three patients died for PP related sepsis.

At multivariate Cox analysis, age older than 60 years and BMI greater than 30 were statistically associated with early PP; whereas male gender and laryngectomy with neck dissection were statistically related to a higher risk of ab ingestis PP.

Interestingly, the occurrence of early PP was a negative independent prognostic factor for 5-years disease-free and actuarial survival (p=0.049 and p=0.001, respectively).

The occurrence of early-onset pneumonia in laryngeal cancer patients selected for conservative laryngectomies is predictable and associated with poor clinical outcome.

Abbreviation: PP, postoperative pneumonia

Keywords: Pneumonia, Partial laryngectomies, Prognosis, Surgical complications, Supraglottic and supracricoid surgery, Body mass index