Prognostic Impact of Primary Tracheostomy in Laryngeal Squamous Cell Carcinoma: A Retrospective Comparative Study

Abstract

Background: Laryngeal squamous cell carcinoma (LSCC) is a prevalent head and neck malignancy with significant morbidity and mortality. Primary tracheostomy is frequently required for acute airway obstruction; however, its prognostic implications remain poorly characterized, particularly in North African settings where advanced-stage presentation is prevalent.

Objectives: To compare oncological and postoperative outcomes between LSCC patients who underwent primary tracheostomy and those who did not.

Methods: Retrospective comparative study of 100 patients operated on for histologically confirmed LSCC at the Department of Otorhinolaryngology and Head and Neck Surgery, 20 August 1953 hospital, CHU Ibn Rochd, Casablanca, Morocco (January 2017–December 2023). Patients were stratified by tracheostomy status. Categorical variables were compared using Chi-square and Fisher’s exact tests (IBM SPSS v20; p < 0.05).

Results: The cohort was 97% male, mean age 63 ± 10 years; 82% were active smokers. Primary tracheostomy was performed in 58% of patients, all of whom subsequently underwent total laryngectomy. All-cause mortality was significantly higher in the tracheostomy group (46.6% vs. 16.7%, p = 0.002), and disease-free survival was markedly lower (48.3% vs. 81.0%, p = 0.001). Pharyngocutaneous fistula (8.6% vs. 0%, p = 0.018) and radiomucositis (19.0% vs. 4.8%, p = 0.037) were significantly more frequent in tracheostomized patients.

Conclusion: Primary tracheostomy is associated with significantly poorer oncological and postoperative outcomes in LSCC, reflecting advanced tumor burden at presentation. Early diagnosis, timely adjuvant radiotherapy, and multidisciplinary management are essential to improve prognosis in this high-risk population.