Results of surgical salvage for radiation failures of laryngeal carcinoma ANTHONYPO WING YUEN,FRCSE, FRCSG, DLO, WILLIAM IGNACEWEI, MS, FRCSE, FACS, DLO, and CHIU MING HO, FRCSE, FRACS, Hong Kong The results of surgicai salvage of radiation failures of laryngeal carcinoma were reviewed. There were 167 stage T3 and T4 patients. The operative mortality was 7%. The complication rates were 8% wound infection, 13% chest complication, and 25% anastomotic leakage. After the first salvage operation, pharyngeal recurrence developed in 28 (18%) patients. Seven (25%) patients were feasible for second salvage operation, and none of them had turther Iocal recurrence. There were 9 [5%] tracheostomal recurrencesù Of the 126 N0 patients, 23 (I 8%) had nodai recurrence, and only 5 of the nodal recurrences were teasibie for salvage by radicaJ neck dissection. All 41 hode-positive patients underwent radical neck dissection, and 9 (23%] had nodal recurrence. Of the 12ö node-negative patients, 19 (15%] had distant metastasls. Of the 41 node-positive patients, 18 [44%] had distant metastasis. The node-positive patients had a significantly high distant failure rate despite Iocoregional control of tumor. The adjusted 5-year survival rate of T3-4NOM0 was 45%, and that of T3-4 N + M0 was 22%. [©T©~RYNG©L HEAD NECK $URG 1995;I 12:405-9,) Early T1 and T2 laryngeal carcinomas can be treated equally effectively with either radiotherapy or partial laryngectomy with preservation of laryn- geal function. 1,2 Radiotherapy is more commonly used because the voice is better after radiotherapy than after partial laryngectomy. The treatment policy for advanced laryngeal carcinoma remains controversial. Surgery, radiotherapy, and chemo- therapy are used in various combinations by differ- ent centers. 3-9 Although surgery can achieve better local control of advanced stage tumor, it has the disadvantage of loss of the larynx. The resulting disability may not be acceptable by the patients. Many patients still prefer radiotherapy as the initial treatment to preserve their laryngeal functions. However, up to 20% of early tumors and more than 60% of advanced laryngeal carcinomas fail with the radiotherapy, and these patients require surgical From the Department of Surgery,The University of Hong Kong, Queen Mary Hospital. This study was supported by Committeeon Research and Con- ference Grants of The University of Hon~ Kong grant no. 337/048/0014. Received for publication June 29, 1994; accepted Sept. 30, 1994. Reprint requests: Dr. Anthony P. W. Yuen, Department of Surgery, University of Hong Kong, Quee~LMary Hospital, Pokfulam Road, Hong Kong. Copyright© 1995by the AmericanAcademy of Otolaryngology- Head and Neck SurgeryFoundation, Inc. 0194-5998/95/$3.00 + 0 23/1/61)950 salvage, ml Although some patients stil1 have eariy disease on recurrence, most patients present with advanced locoregional recurrence after radio- therapy. The progress of early to advanced disease on recurrence may be due to the inadequacy of clinical assessment and follow-up of these patients, but more important is the difficulty of detection of early recurrence of the irradiated larynx even by direct laryngoscopy and biopsy. With the increasing popularity of organ preservation by treatment with combination chemotherapy and radiotherapy, with surgery in reserve for all stages of disease, it is necessary to provide more information on the prog- nosis of these patients when radiotherapy fails. It has been reported that early recurrence of stage T1 and T2 has good results by surgicat salvage. 12,1s There is no large series documenting the long-term results of surgical salvage for radiation failure when the recnrrence is of advanced T3 and T4 stage. This article aims at the analysis of our 20 years of clinical experience of surgical salvage for recurrent ad- vanced laryngeal carcinoma after radiotherapy failnre. PATIENTS AND METHODS This is a review of the clinical experience of surgical salvage for radiation failures of laryngeal carcinoma in the Department of Surgery, The Uni- versity of Hong Kong, Queen Mary Hospital, Hong Kong. All records of salvage operations between 405