(649) Silent Scars: Psychiatric Outcomes Following Extirpative and Organ-Preserving Laryngeal Cancer Interventions

Introduction: Psychiatric morbidity is a key consequence of laryngeal interventions, yet comparative outcomes among surgical approaches remain understudied. Our objective was to compare psychiatric morbidity following total laryngectomy (TL), partial laryngectomy (PL), and non-extirpative chemotherapy or radiotherapy (NE) in patients with laryngeal cancer.

Methods: A retrospective cohort study was done using the US EHR TriNetX database including 121,384,912 patients in 70 healthcare organizations from 2014 to 2025. Adults ≥ 18 with laryngeal cancer undergoing treatment with TL, PL, or NE were identified using ICD and CPT codes. The primary outcome was new-onset depression; secondary outcomes were new-onset anxiety, suicidality, alcohol disorders, and opioid disorders. Risk differences (RD) were calculated; significance at p< 0.05.

Results: Patients were identified at 1-year and 3-year windows; pair-wise comparisons were made. After propensity score matching, 1-year cohorts included 691 patients in each of the TL and PL groups and 3,523 in each of the TL and NE groups; 3-year cohorts included 838 patients in each of the TL and PL groups and 2,881 in each of the TL and NE groups.At 1 year, TL was associated with higher rates of depression compared with PL (RD 5.01%) and NE (RD 4.71%) (all p< 0.05). TL was also associated with higher 1-year rates of anxiety (RD 3.95% vs PL; RD 5.61% vs NE, all p< 0.05); additionally, suicidality (RD 0.58% vs NE) and alcohol-related disorders (RD 1.49% vs NE) were more frequent (both p< 0.01). At 3 years, TL remained associated with higher rates of depression compared with PL (RD 4.93%) and NE (RD 4.55%). TL 3-year anxiety rates were similarly increased compared with both PL (RD 4.04%) and NE (RD 4.43%) (all p< 0.05). Opioid use disorder incidence did not differ significantly among groups at either time point, and psychiatric outcomes were otherwise comparable between PL and NE.

Conclusions: TL confers significantly higher psychiatric morbidity compared to less-invasive procedures, supporting longitudinal psychiatric surveillance for patients.