Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: Impact of early decannulation on dysphagia outcomes following supracricoid laryngectomy

OBJECTIVES: Early decannulation, performed within the first ten days after supracricoid partial laryngectomy, can result in a more rapid recovery of swallowing function with a semisolid bolus in the short term, about 30 days. METHODS: We selected 20 patients with squamous cell carcinoma of larynx, who underwent supracricoid laryngectomies: 10 cricohyoidopexy (CHP) and 10 cricohyoidoepiglottopexy (CHEP). Staging was pT2 (10 pts), and pT3 (10 pts). Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was used to assess postoperative swallowing function after a mean of 12 and 22 days from surgery. A modified PAS Score (Penetration-Aspiration Scale) was assigned for subtotal laryngectomies. RESULTS: Decannulation occurred after 6.7 ± 2.1 days. Univariate analysis showed that the type of surgery (CHP or CHEP), pT, resection of one arytenoid, and decannulation time are significantly associated with the 12-day PAS Score. The 22-day PAS score is significantly associated with only 3 variables: type of surgery, pT, and resection of one arytenoid. CONCLUSION: From the data presented, the factors that most delay an effective recovery of swallowing are T3 and the resection of one arytenoid. Early decannulation has been shown statistically to improve PAS score in the short term, but not in the long term. In the literature, the average decannulation time ranges from 8 to 105 days, with a decannulation rate ranging from 85.7% to 100% of patients.