From the Guidelines
A consent form for laryngectomy should include several key risks to ensure patients are fully informed before surgery, prioritizing morbidity, mortality, and quality of life as the primary outcomes. The form should detail the risk of permanent voice loss requiring alternative communication methods such as electrolarynx, esophageal speech, or tracheoesophageal puncture, as highlighted in the 2018 American Society of Clinical Oncology clinical practice guideline update 1. Breathing changes must be addressed, explaining that patients will breathe through a permanent stoma in the neck rather than the nose and mouth. Swallowing difficulties are common after surgery and may require dietary modifications or feeding tube placement, with a reported incidence of dysphagia and aspiration pneumonia in up to 50% of survivors of advanced head and neck cancer 1.
The form should mention potential complications including:
- Infection
- Bleeding
- Fistula formation (abnormal connections between the throat and skin)
- Narrowing of the stoma
- Pharyngeal stenosis There are also risks of damage to surrounding structures including nerves (particularly the recurrent laryngeal and vagus nerves), blood vessels, and the esophagus, as noted in the 2018 guideline update 1. The psychological impact of altered appearance, permanent stoma, and communication changes should be acknowledged, with social isolation, job loss, and depression being common sequelae 1.
Additional risks include:
- Mucus production changes requiring frequent cleaning of the stoma
- Reduced ability to smell and taste
- The possibility of aspiration pneumonia, with a reported lifetime risk of 25% and 30% in patients with laryngeal and hypopharyngeal cancers, respectively 1 The form should also note the risk of cancer recurrence despite surgery, as well as standard surgical risks like anesthesia complications, blood clots, and wound healing problems, as discussed in the 2018 guideline update 1. These risks are essential to disclose as laryngectomy significantly alters basic functions and physical appearance, requiring substantial lifestyle adjustments.
From the Research
Risks to Include on a Consent Form for Laryngectomy
The following risks should be considered for inclusion on a consent form for laryngectomy:
- Postoperative complications, such as wound infection, bleeding, and wound necrosis 2
- Fistula formation, which can occur in up to 42.3% of patients 2
- Stenosis of the pharynx/oesophagus and stoma shrinkage, which can occur in up to 18.2% of cases 2
- Respiratory infections, such as tracheobronchitis and pneumonia, which can be more common in laryngectomized patients 3
- Anastomotic complications, such as granulation tissue formation, stricture, and separation, which can be major complications following tracheal resection 4
- Vocal cord edema, recurrent laryngeal nerve injury, esophageal injury, swallowing dysfunction, aspiration pneumonia, and fistula to the esophagus or innominate artery, which are other potential complications to consider 4
- The potential requirement for blood transfusion, which should be discussed with patients 5
Patient-Specific Risk Factors
Certain patient-specific risk factors should also be considered when obtaining informed consent for laryngectomy, including:
- Smoking status, which is a significant risk factor for postoperative complications and fistula formation 2
- Chronic obstructive pulmonary disease (COPD), which is also a significant risk factor for postoperative complications and fistula formation 2
- Tumour localisation in the hypopharynx, which is associated with overall postoperative complications 2
- Residual tumour or cancer recurrence, which is associated with late-onset fistulas 2
- Age, diabetes, and need for preoperative tracheostomy, which are risk factors for postoperative anastomotic complications 4