Surgical treatment of stomal recurrences in cancer of the larynx

A study of 124 cases of cancer of the larynx treated by surgery in a general hospital revealed nine cases of stomal recurrence, that is, a recurrence at the junction of the amputated trachea and skin. Our studies suggest that the following factors may play a role in the development of this problem: preliminary tracheostomy or laryngofissure or the use of the endotracheal tube and possible tumor implantation, and inadequate initial surgery for large tumors of the vocal cords or subglottic lesions. Laryngectomy and routine radical neck dissection should be employed. If laryngectomy alone is performed, the hemithyroid should be removed on the side of the lesion in cases of small lesions. Our studies also suggest that there is a possible multicentricity of the primary lesion as indicated by the high incidence of larynx and lung cancers occurring as multiple primary lesions, and that similar etiologic factors may play a role in reducing the host resistance and allowing the stomal recurrence to develop.