Stomal recurrences: a clinicopathological analysis and protocol for future management.

From 1965 to 1975, 452 total laryngectomies were performed at the Washington University Medical Center, St. Louis, Mo. During this period, 33 stomal recurrences were diagnosed. These are clinicopathologically analyzed with regard to tumor size, site, histopathology and original surgical procedure. An association with transglottic tumors, emergency tracheotomy and, surprisingly, hemilaryngectomy is noted. Three theories of etiology are discussed. Since treatment to date is disappointing, several proposed methods of prophylaxis are presented. These include emergency laryngectomy, recurrent laryngeal lymphatic dissection and postoperative radiotherapy. The role of wide local excision and mediastinal dissection is also examined. Based upon the analysis and the proposed methods of prophylaxis, a protocol is suggested for the future management of this dreaded complication.