Which risk factors are associated with stomal recurrence after total laryngectomy for laryngeal cancer? A meta-analysis of the last 30 years.

Introduction: Stomal recurrence is a troublesome complication after total laryngectomy. Despite a large number of studies having been performed, there is still controversy about which risk factors are most significant for the development of stomal recurrence. Objective: The objective of the present meta-analysis was to analyze the potential factors leading to stomal recurrence after total laryngectomy. Methods: PubMed, Web of Science, Cochrane Library, and Ovid databases were systematically searched using multiple search terms. Eighteen studies with 6462 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence. Results: The results showed that, tumor subsite (supraglottic vs. subglottic, RR =0.292, 95% CI 0.142-0.600, p=0.001; glottic vs. subglottic, RR= 0.344, 95% CI 0.175-0.676, p = 0.002), T stage (RR= 0.461, 95% CI 0.286-0.742, p= 0.001), preoperative tracheotomy (RR =1.959, 95% CI 1.500-2.558, p< 0.001) were the high-risk factors associated with the development of stomal recurrence. Conclusion: From the results of our study, tumor subsite, T stage and preoperative tracheotomy were the significant risk factors for stomal recurrence. Methodologically high-quality comparative investigations are needed for further evaluation. (C) 2020 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.