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Advanced laryngeal cancer with skin infiltration: Survival analysis




The objective of this study was to investigate T4 laryngeal cancer patients with skin infiltration regarding survival and different variables that may influence the survival.

Study design

This was a retrospective analytic study.

Materials and methods

This study included 14 patients suffering from laryngeal carcinoma, with tumor extending to involve the skin of the front of the neck. Total laryngectomy was performed for all patients together with excision of the overlying skin, and pectoralis major myocutaneous flap was used for reconstruction of the skin defect in all patients. Analysis of the preoperative, operative, postoperative, and follow-up patients’ data was performed. The 1-, 2-, 3-, and 5-year survival rates were estimated.


The overall mean survival time for all patients was 51.1 ± 8.3 months. The mean survival time for patients with recurrent disease was 16.4 ± 3.5 months and for patients without recurrent disease was 70.7 ± 6 months. The 1-, 2-, 3-, and 5-year survival rates were 92.9, 71.4, 64.3, and 50%, respectively. The univariate analysis revealed that previous treatment before definitive surgery was the only variable that had a statistical influence on the overall 5-year survival rate (P = 0.046).


Extended laryngectomy with skin removal offers reasonable 5-year survival rate for T4 laryngeal cancer patients with skin invasion, and reconstruction of the neck skin defect with a pectoralis major myocutaneous flap is a reliable method of repair.


  1. Rifai M, Mebed H, Bassiouni M. Direct extension of laryngeal carcinoma to the skin of the neck. J Laryngol Otol 1990; 104: 824–826.

    Article  CAS  Google Scholar 

  2. Jin J, Liao Z, Gao L, Huang X, Xu G. Analysis of prognostic factors for T1N0M0 glottic cancer treated with definitive radiotherapy alone: experience of the cancer hospital of Peking Union Medical College and the Chinese Academy of Medical Sciences. Int J Radiat Oncol Biol Phys 2002; 54: 471–478.

    Article  Google Scholar 

  3. Haugen H, Johansson K-A, Mercke C. Hyperfractionated-accelerated or conventionally fractionated radiotherapy for early glottic cancer. Int J Radiat Oncol Biol Phys 2002; 52: 109–119.

    Article  Google Scholar 

  4. Back G, Sood S. The management of early laryngeal cancer: options for patients and therapists. Curr Opin Otolaryngol Head Neck Surg 2005; 13: 85–91.

    Article  Google Scholar 

  5. Spector GJ, Sessions DG, Lenox J, Newland D, Simpson J, Haughey BH. Management of stage IV glottic carcinoma: therapeutic outcomes. Laryngoscope 2004; 114: 1438–1446.

    Article  Google Scholar 

  6. Croce A, Moretti A, Bianchedi M, Neri G, Falcone G. Widened forwarding total laryngectomy (‘squared laryngectomy’). Hints of surgical techniques and personal experience. Acta Otorhinolaryngol Ital 1995; 15: 355–360.

    PubMed  CAS  Google Scholar 

  7. Chen AY, Fedewa S, Zhu J. Temporal trends in the treatment of early-and advanced-stage laryngeal cancer in the United States, 1985–2007. Arch Otolaryngol Head Neck Surg 2011; 137: 1017–1024.

    Article  Google Scholar 

  8. Rudolph E, Dyckhoff G, Becher H, Dietz A, Ramroth H. Effects of tumour stage, comorbidity and therapy on survival of laryngeal cancer patients: a systematic review and a meta-analysis. Eur Arch Otrhinolaryngol 2011; 268: 165–179.

    Article  Google Scholar 

  9. Ariyan S, Cuono CB. Use of the pectoralis major myocutaneous flap for reconstruction of large cervical, facial or cranial defects. Am J Surg 1980; 140: 503–506.

    Article  Google Scholar 

  10. Leemans CR, Balm AJM, Gregor RT, Hilgers FJM. Management of carotid artery exposure with pectoralis major myofascial flap transfer and split-thickness skin coverage. J Laryngol Otol 1995; 109:1176–1180.

    Article  CAS  Google Scholar 

  11. Patel UA, Keni SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009; 141:190–195.

    Article  Google Scholar 

  12. Bresson K, Rasmussen H, Attrup Rasmussen P. Pharyngo-cutaneous fistulae in totally laryngectomized patients. J Laryngol Otol 1974; 88:835–842.

    Article  CAS  Google Scholar 

  13. Thawley SE. Complications of combined radiation therapy and surgery for carcinoma of the larynx and inferior hypopharynx. Laryngoscope 1981; 91:677–700.

    Article  CAS  Google Scholar 

  14. Mclean JN, Nicholas C, Duggal P, Chen A, Grist WG, Losken A, Carlson GW. Surgical management of pharyngocutaneous fistula after total laryngectomy. Ann Plast Surg 2012; 68:442–445.

    Article  CAS  Google Scholar 

  15. Grau C, Johansen LV, Hansen HS, Andersen E, Godballe C, Andersen LJ, et al. Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: a national survey from Dahanca. Head Neck 2003; 25:711–716.

    Article  Google Scholar 

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Correspondence to Mohamed Mosleh MD.

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Mosleh, M., Fathy, H. Advanced laryngeal cancer with skin infiltration: Survival analysis. Egypt J Otolaryngol 30, 122–125 (2014).

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