Quality of Life After Total Laryngectomy - Review

Background Total laryngectomy represents a radical surgical treatment option for patients with malignant tumors involving the larynx. By excision of the larynx and the subsequent reconstruction of the remaining pharynx as well as separating the trachea from the pharynx by creating a permanent tracheal stoma, the patient is left with a deglutition and phonation handicap. However, if after surgical healing, oral feeding can be resumed, speaking is impossible for a laryngectomee without specialized interventions and techniques. This handicap and the anxiety generated from it is the one that keeps most patients proposed for a total laryngectomy from being operated and opting for alternative oncologic treatment using radiation and concurrent chemotherapy, even if surgery offers the best chance for long-term survival. Methodology A review of existing literature was performed to determine the main issues affecting the quality of life of a total laryngectomee, with hope to determine the best way to improve it, and to offer a viable alternative to the better functional outcome of oncologic treatment. Main databases were searched for relevant publications in regard to quality-of-life markers and techniques for improvement. Results and Conclusions Vocal and swallowing rehabilitation are key for obtaining a reasonable QoL. Primary TEP with vocal prosthesis placement is currently the method of choice for vocal rehabilitation. Postoperative adjuvant radiation and chemotherapy have the most negative impact, but are essential to assuring best long-term survival. Also, complications related to TEP prosthesis placement have a major negative impact on the patient's QoL. Psychological counseling before and after the laryngectomy, as well as support groups have a major positive impact on the QoL of laryngectomees.