Study Highlights Role of Surgical Factors in Post-Laryngectomy Hypocalcemia Management
Iran: A recent spanning eight years has shed light on the key factors contributing to post-surgical hypocalcemia (< 8.5 mg/dl) in laryngectomy patients.
"Although average calcium levels showed no significant change, adjusting for albumin levels revealed a decrease in postoperative calcium. Total thyroidectomy, neck dissection, pre-operative hypocalcemia, and prior radiotherapy emerged as robust predictors of post-laryngectomy hypocalcemia," the researchers reported in the Indian Journal of Otolaryngology and Head & Neck Surgery.
Laryngeal cancer represents a prevalent form of advanced head and neck malignancy. Treatment typically involves surgery, radiation therapy, chemotherapy, or a combination thereof, for managing locally advanced cases. Despite its invasive nature, total laryngectomy is commonly recommended for T3-4 laryngeal cancers. Following neck compartment surgeries like laryngectomy, patients are susceptible to post-surgical hypocalcemia due to the potential development of hyperparathyroidism.
Against the above background, Mahdi Khajavi, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and colleagues aimed to investigate the risk factors and prevalence of hypocalcemia in individuals following laryngectomy.
For this purpose, the researchers conducted a retrospective study investigating 50 consecutive laryngectomy patients over eight years. Data on medical history, demographic characteristics, surgical details, neck dissection laterality, pre- and post-operative calcium levels, and history of radiotherapy were collected.
Hypocalcemia was defined as calcium levels below 8.5 mg/dl or corrected calcium levels below 8.5 mg/dl. Statistical analyses included Wilcoxon signed-rank tests, paired t-tests, and binary logistic regression using R studio.
The study led to the following findings:
· The mean age of participants was 59 years, predominating males (94%) and habitual smokers (94%).
· Squamous cell carcinoma was the most prevalent (98%) pathological diagnosis, and various surgical techniques were employed.
· While initial comparisons showed no significant changes in calcium levels pre- and post-operatively, adjusting for albumin levels revealed a significant association.
· Logistic regression identified neck dissection, low pre-operative calcium, radiotherapy, and total thyroidectomy as significant predictors of postoperative hypocalcemia.
The findings showed that surgical factors such as total thyroidectomy and neck dissection, alongside albumin levels, significantly impact postoperative hypocalcemia, the researchers wrote.
"These findings emphasize the importance of vigilant monitoring and proactive measures to address calcium imbalance following laryngectomy," they concluded.
Reference:
Zaker, A., Peyvandi, A., Fazli, M. et al. Investigating the Incidence and Risk Factors of Hypocalcemia After Laryngectomy. Indian J Otolaryngol Head Neck Surg (2024). https://doi.org/10.1007/s12070-024-04790-w
