Tracheostomal recurrences after laryngectomy.

A clinicopathologic study of 681 laryngectomies performed at the Otorhinolaryngology Clinic of the University of Ferrara forms the basis here of a discussion of the etiopathogenesis of the postsurgical tracheostomal recurrence. Special attention is paid to the much debated etiopathogenetic role of preoperative tracheotomy. In all classes of material analyzed, tracheostomal recurrence was more frequent in patients with preoperative tracheotomy, though the percentages varied depending on the class. Morphological analysis of original tumor specimens from preoperatively trachetomized patients who later had tracheostomal recurrence, revealed tumors in 4 out of the 11 usable specimens. Of these, two had submucosal infiltration in a peripheral digitation of the tumor; in the other two cases, no contact was observed between the neoplastic infiltration and the outer border of the original tumor. The authors also reviewed the case histories of patients in whom conservative surgery was followed by total laryngectomy because of endolaryngeal recurrence. The high rate of tracheostomal recurrence in this category of patients suggests that the pathogenetic mechanism may be analogous in the two situations: preoperative tracheotomy/tracheostomal recurrence and inadequate conservative surgery/tracheostomal recurrence.