Tumor infiltration around the tracheal stoma following total laryngectomy remains a serious complication of laryngeal cancer. Usually asymptomatic, this type of recurrence appears only as a slight bulge into the tracheal lumen, as gradual narrowing of the stomal orifice, or as persistent "granulation tissue" at the tracheocutaneous junction. Recurrent disease at this site, though asymptomatic, is usually fatal.
Suspicion that these lesions might be preventable stimulated an investigation of the patients who experienced peristomal recurrence; there were 17 in a series of 116 who underwent total laryngectomy. The results, presented in the February issue of the Archives of Otolaryngology,1 implicate preoperative tracheostomy as the most important etiologic factor. Implantation of viable cancer cells in exposed tissue at the site of the tracheostomy appears to be the mechanism by which the tumor recurs, rather than via the paratracheal lymphatics. The investigators were unable to correlate the incidence of peristomal recurrence
WHEN IS TRACHEOSTOMY NOT INDICATED? JAMA. 1965;191(7):593–594. doi:10.1001/jama.1965.03080070077013
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