Stomal recurrence--etiologic factors and prevention.

Out of a total of 340 laryngectomies performed in the Department of Otorhinolaryngology at Kobe University Hospital from 1969 to 1982, there were 20 stomal recurrences. In the preoperative tracheostomy group, 6 out of 52 patients (11.5%) developed stomal recurrence compared to 14 out of 288 (4.9%) in the operative tracheostomy group. Of these 20 stomal recurrences, 7 were supraglottic with 1 subglottic extension, 9 were glottic with 8 subglottic extensions, and 4 were primary subglottic cancers. The mean interval between the laryngectomy and stomal recurrence was 16 months and ranged from 20 days to 55 months after laryngectomy. We analyzed our series together with recent material which had been subjected to pretracheal and paratracheal lymphatic dissection. Reports from the literature were also used. Tumor cell inoculation in the tracheostomy wound and persistent pretracheal and paratracheal lymph node lesion are the two most likely major etiologic factors. The above evaluation leads us to propose the following preventive measures: 1) thorough irrigation of the wound following the removal of the larynx, 2) complete excision of the tracheostomy tract for preoperatively tracheostomized patients, 3) pretracheal and paratracheal lymphatic dissection for subglottic lesion, 4) in the above cases, laryngectomy should be followed by peristomal radiotherapy.