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Prevention of pharyngocutaneous fistula in salvage total laryngectomy: role of the pectoralis major flap and peri-operative management. The Journal of Laryngology & Otology 2018; 132:246-251. [PMID: 29512475 DOI: 10.1017/s0022215118000178] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of an onlay pectoralis major flap in reducing the incidence of pharyngocutaneous fistula after salvage total laryngectomy and determine the complications of pectoralis major flap reconstruction. METHODS A retrospective study was conducted of consecutive patients who underwent salvage total laryngectomy between 1995 and 2016. The pharyngeal defects were primarily closed with or without the pectoralis major flap. RESULTS Of 64 patients, 34 had primary pharyngeal closure alone (control group) and 30 received an onlay pectoralis major flap (pectoralis major flap group). The overall fistula rate was 15.6 per cent, with 17.6 per cent occurring in the control group and 13.3 per cent in the pectoralis major flap group (p = 0.74). The incidence rates of voice failure (p = 0.02) and shoulder disability (p < 0.001) were significantly higher in the pectoralis major flap group. CONCLUSION The pectoralis major flap in salvage total laryngectomy did not decrease the pharyngocutaneous fistula rate, and the incidence of flap-related complications was high. Appropriate surgical technique and post-operative care may reduce the incidence of pharyngocutaneous fistula.
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Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit. Eur Arch Otorhinolaryngol 2018; 275:783-794. [DOI: 10.1007/s00405-017-4861-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/29/2017] [Indexed: 11/26/2022]
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Kiong KL, Tan NC, Skanthakumar T, Teo CEH, Soo KC, Tan HK, Roche E, Yee K, Iyer NG. Salivary fistula: Blue dye testing as part of an algorithm for early diagnosis. Laryngoscope Investig Otolaryngol 2017; 2:363-368. [PMID: 29299509 PMCID: PMC5743154 DOI: 10.1002/lio2.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/18/2017] [Accepted: 09/06/2017] [Indexed: 11/10/2022] Open
Abstract
Objective Orocutaneous and pharyngocutaneous fistula (OPCF) is a debilitating complication of head and neck surgery for squamous cell carcinoma (SCC), resulting in delayed adjuvant treatment and prolonged hospitalization. As yet, there is no established test that can help in prompt and accurate diagnosis of OPCF. This study aims to determine the accuracy of bedside blue dye testing and its role as part of an algorithm for early diagnosis. We also analyze the risk factors predisposing to OPCF. Study Design Retrospective cohort study from 2012 to 2014. Methods Patients with head and neck SCC who underwent major resection and reconstruction, at risk of OPCF, were included. Results of blue‐dye and video‐fluoroscopic swallow‐studies (VFSS) testing for OPCF were recorded. For the patients that were noted to develop OPCF, the length of time to diagnosis of fistula and subsequent mode of management were examined. Results Of the 93 patients in this study, 25 (26.9%) developed OPCF. Advanced T‐classification (T3/T4) was the only significant predisposing risk factor (p = 0.013). The sensitivity and specificity of the bedside blue dye testing was found to be 36.4% and 100%, respectively. The test positive patients were diagnosed with OPCF at a median of postoperative day (POD) 9.5 as compared to POD 13 for the test negative patients (p = 0.001). Early diagnosis was associated with faster fistula resolution with treatment. Conclusion Blue dye testing is a simple bedside test that can assist in the early diagnosis of OPCF in patients, allowing treatment to be instituted earlier with improved outcomes. Level of Evidence 3
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Affiliation(s)
| | | | | | | | - Khee Chee Soo
- the Division of Surgical Oncology National Cancer Centre Singapore
| | | | - Elizabeth Roche
- Department of Speech Therapy Singapore General Hospital Singapore
| | - Kaisin Yee
- Department of Speech Therapy Singapore General Hospital Singapore
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Partington EJ, Moore LS, Kahmke R, Warram JM, Carroll W, Rosenthal EL, Greene BJ. Laser-Assisted Indocyanine Green Dye Angiography for Postoperative Fistulas After Salvage Laryngectomy. JAMA Otolaryngol Head Neck Surg 2017; 143:775-781. [PMID: 28520896 DOI: 10.1001/jamaoto.2017.0187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pharyngocutaneous fistula formation is an unfortunate complication after salvage laryngectomy for head and neck cancer that is difficult to anticipate and related to a variety of factors, including the viability of native pharyngeal mucosa. Objective To examine whether noninvasive angiography with indocyanine green (ICG) dye can be used to evaluate native pharyngeal vascularity to anticipate pharyngocutaneous fistula development. Design, Setting, and Participants This cohort study included 37 patients enrolled from June 1, 2013, to June 1, 2016, and follow-up was for at least 1 month postoperatively. The study was performed at the University of Alabama at Birmingham, a tertiary care center. Included patients were those undergoing salvage total laryngectomy who were previously treated with chemoradiotherapy or radiotherapy alone. Exposures The ICG dye was injected intraoperatively, and laser-assisted vascular imaging was used to evaluate the native pharyngeal mucosa after the ablative procedure. The center of the native pharyngeal mucosa was used as the reference to compare with the peripheral mucosa, and the lowest mean ICG dye percentage of mucosal perfusion was recorded for each patient. Main Outcomes and Measures The primary outcome was the formation of a postoperative fistula, which was assessed by clinical and radiographic assessment to test the hypothesis formulated before data collection. Results A total of 37 patients were included (mean [SD] age, 62.3 [8.5] years; 32 [87%] male and 5 [14%] female); 20 had a history of chemoradiotherapy, and 17 had history of radiotherapy alone. Thirty-four patients (92%) had free flap reconstruction, and 3 had primary closure (8%). Ten patients (27%) developed a postoperative fistula. No significant difference was found in fistula rate between patients who underwent neck dissection and those who did not and patients previously treated with chemoradiotherapy and those treated with radiotherapy alone. A receiver operator characteristic curve was generated to determine the diagnostic performance of the lowest mean ICG dye percentage of mucosal perfusion determined by fluorescence imaging, which was found to be a threshold value of 26%. The area under the curve was 0.85 (95% CI, 0.73-0.97), which was significantly greater than the chance diagonal. The overall mean lowest ICG dye percentage of mucosal perfusion was 31.3%. The mean lowest ICG dye percentage of mucosal perfusion was 22.0% in the fistula group vs 34.9% in the nonfistula group (absolute difference, 12.9%; 95% CI, 5.1%-21.7%). Conclusions and Relevance Patients who developed postoperative fistulas had lower mucosal perfusion as detected by ICG dye angiography when compared with patients who did not develop fistulas.
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Affiliation(s)
- Erin J Partington
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham
| | - Lindsay S Moore
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham
| | - Russel Kahmke
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham
| | - William Carroll
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford University, Stanford, California
| | - Benjamin J Greene
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham
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Lebo NL, Caulley L, Alsaffar H, Corsten MJ, Johnson-Obaseki S. Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort. J Otolaryngol Head Neck Surg 2017; 46:54. [PMID: 28830509 PMCID: PMC5568352 DOI: 10.1186/s40463-017-0233-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/14/2017] [Indexed: 11/26/2022] Open
Abstract
Background Pharyngocutaneous fistula (PCF) is a problematic complication following total laryngectomy. Disagreement remains regarding predisposing factors. This study examines perioperative factors predicting PCF following total laryngectomy using a large multicenter data registry. Methods Retrospective cohort analysis was performed using patients undergoing total laryngectomy in the ACS-NSQIP database for 2006–2014. Sub-analysis was performed based on reconstruction type. Outcome of interest was PCF development within 30 days. Results Multivariate analysis of 971 patients was performed. Three variables showed statistical significance in predicting PCF: wound classification of 3 and 4 vs. 1–2 (OR 6.42 P < 0.0004 and OR 8.87, P < 0.0042), pre-operative transfusion of > 4 units of packed red blood cells (OR 6.28, P = 0.043), and free flap versus no flap reconstruction (OR 2.81, P = 0.008). Conclusions This study identifies important risk factors for development of PCF following total laryngectomy in a large, multi-institutional cohort of patients, thereby identifying a subset of patients at increased risk.
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Affiliation(s)
- Nicole L Lebo
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, S3, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | - Lisa Caulley
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, S3, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Hussain Alsaffar
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, S3, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Martin J Corsten
- Department of Otolaryngology, Aurora Health Care, Aurora St. Luke's Hospital, Milwaukee, WI, USA
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, S3, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
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Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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Wiegand S. Evidence and evidence gaps of laryngeal cancer surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc03. [PMID: 28025603 PMCID: PMC5169076 DOI: 10.3205/cto000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number or organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery, and transoral robotic surgery have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the US. Improving the evidence base of laryngeal cancer surgery by successful establishment of surgical trials should be the future goal.
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Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head & Neck Surgery, University Hospital of Leipzig, Germany
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58
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Ferrari D, Codecà C, Viale G, Bocci B, Broggio F, Crepaldi F, Violati M, Luciani A, Bauer D, Moneghini L, Bulfamante G, Foa P. An unusual case of tracheo-pleural fistula and cardiac metastases in oropharyngeal carcinoma: a case report and review of the literature. CANCERS OF THE HEAD & NECK 2016; 1:16. [PMID: 31093345 PMCID: PMC6460740 DOI: 10.1186/s41199-016-0018-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/21/2016] [Indexed: 01/03/2023]
Abstract
Background Oropharyngeal cancer is frequently associated with human papilloma virus, that also represents a strong prognostic factor. Local relaps and treatment-related complications are frequent, whereas distant metastases occur in about 25% of patients. Case presentation A 49 years-old male presented with a loco-regionally advanced oropharyngeal squamous cell carcinoma and was treated with concomitant chemoradiation. A complete clinical and pathological response was achieved, but the occurrence of necrotising tracheo-esophagitis, with tracheo-mediastino-pleural fistula formation, further complicated the subsequent clinical course. The patient died suddenly. Autopsy revealed multiple myocardial and epicardial metastases from oropharyngeal squamous cell carcinoma. Conclusions Even in case of a transient complete local response, the potential occurrence of severe complications and distant metastases, although infrequent, should be considered. Cardiac metastases are frequently underestimated, as they are often asymptomatic, but may lead to sudden death. Further efforts are needed to improve diagnosis and therapy in this setting.
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Affiliation(s)
- Daris Ferrari
- 1Medical Oncology, San Paolo Hospital, Milan, Italy.,5San Paolo Hospital, via Di Rudinì 8, 20142 Milan, Italy
| | - Carla Codecà
- 1Medical Oncology, San Paolo Hospital, Milan, Italy
| | - Giulia Viale
- 1Medical Oncology, San Paolo Hospital, Milan, Italy
| | | | | | | | | | | | - Dario Bauer
- 2Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Laura Moneghini
- 2Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Gaetano Bulfamante
- 3Department of Medicine, Surgery and Dentistry, Division of Pathology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
| | - Paolo Foa
- 4Department of Oncology, Medical Oncology, San Paolo Hospital, University of Milan Medical School, Milan, Italy
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Eskiizmir G, Baskın Y, Yalçın F, Ellidokuz H, Ferris RL. Risk factors for radiation failure in early-stage glottic carcinoma: A systematic review and meta-analysis. Oral Oncol 2016; 62:90-100. [PMID: 27865377 DOI: 10.1016/j.oraloncology.2016.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/08/2016] [Accepted: 10/16/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radiotherapy is one of the main treatment modalities for early-stage glottic carcinoma. Unfortunately, local failure may occur in a group of cases with T1-T2 glottic carcinoma. This meta-analysis sought to determine risk factors for radiation failure in patients with early-stage glottic carcinoma. METHODS A systematic and comprehensive search was performed for related studies published between 1995 and 2014. The primary end-point was 5-year local control. Data extraction and analysis were performed using the software STATA/SE 13.1 for Windows. RESULTS Twenty-seven studies were eligible. A higher risk of radiation failure was demonstrated in male patients [relative risk (RR): 0.927, p<0.001] and those with low hemoglobin level (RR: 0.891, p<0.001) with a high agreement between studies (I-squared=0.0%). Moreover, T2 tumors (RR: 0.795, p<0.001), tumors with anterior commissure involvement (RR: 0.904, p<0.001), tobacco use during/after therapy (RR: 0.824, p<0.001), and "bulky" tumors (RR: 1.270, p<0.001] or tumors bigger in size (RR: 1.332, p<0.001]. Poorly differentiated tumors had a questionable risk of local failure, although a moderate to high interstudy heterogeneity was determined. A statistically significant contribution was not detected for age, presence of comorbidity, alcohol use or subglottic extension. CONCLUSION This is the first meta-analysis which assessed the potential risk factors for radiation failure in patients with early-stage glottic carcinoma. Gender and pretreatment hemoglobin level are major influential factors associated with radiation failure in patients with early-stage glottic carcinoma. However, prospective, randomized clinical trials may permit better stratification of their relative contributions, and those who may benefit more from upfront surgery.
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Affiliation(s)
- Görkem Eskiizmir
- Celal Bayar University, Department of Otolaryngology-Head and Neck Surgery, Manisa, Turkey.
| | - Yasemin Baskın
- Dokuz Eylül University, Institute of Oncology, Izmir, Turkey
| | - Femin Yalçın
- Katip Celebi University, Department of Engineering Sciences, Izmir, Turkey
| | - Hülya Ellidokuz
- Dokuz Eylül University, Institute of Oncology, Izmir, Turkey
| | - Robert L Ferris
- University of Pittsburgh, Division of Head Neck Surgery, Pittsburgh, PA, United States
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60
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Frisch T. Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction. Head Neck 2016; 39:E29-E33. [PMID: 27704666 DOI: 10.1002/hed.24602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The facial artery myomucosal (FAMM) island flap is a cheek flap, pedicled on the facial artery and suitable for small to medium-sized reconstructions of the oral cavity and neighboring areas. A novel transposition of the flap to the hypopharynx after laryngectomy is presented in this report. METHODS A 58-year-old man, previously irradiated, was laryngopharyngectomized because of a new supraglottic carcinoma. An unexpected need for a flap was solved by tunneling a FAMM island flap lateral to the mandible. The reach and size of the flap were sufficient to close the defect. RESULTS Vitality of the flap was ascertained by fiber endoscopy. No donor-site morbidity was seen. Postoperatively, the patient had a minor stomal fistula with spontaneous healing. CONCLUSION The pedicled FAMM island flap may be considered for smaller reconstructions of the upper hypopharynx. Accessibility, low donor-site morbidity, and recipient tissue similarity count among the advantages. © 2016 Wiley Periodicals, Inc. Head Neck 39: E29-E33, 2017.
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Affiliation(s)
- Thomas Frisch
- Department of Otorhinolaryngology, Head and Neck Surgery, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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61
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Ahmed OH, Marcus S, Tauber JR, Wang B, Fang Y, Lebowitz RA. Efficacy of Perioperative Lumbar Drainage following Endonasal Endoscopic Cerebrospinal Fluid Leak Repair: A Meta-analysis. Otolaryngol Head Neck Surg 2016; 156:52-60. [DOI: 10.1177/0194599816670370] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Perioperative lumbar drain (LD) use in the setting of endoscopic cerebrospinal fluid (CSF) leak repair is a well-established practice. However, recent data suggest that LDs may not provide significant benefit and may thus confer unnecessary risk. To examine this, we conducted a meta-analysis to investigate the effect of LDs on postoperative CSF leak recurrence following endoscopic repair of CSF rhinorrhea. Data Sources A comprehensive search was performed with the following databases: Ovid MEDLINE (1947 to November 2015), EMBASE (1974 to November 2015), Cochrane Review, and PubMed (1990 to November 2015). Review Method A meta-analysis was performed according to PRISMA guidelines. Results A total of 1314 nonduplicate studies were identified in our search. Twelve articles comprising 508 cases met inclusion criteria. Overall, use of LDs was not associated with significantly lower postoperative CSF leak recurrence rates following endoscopic repair of CSF rhinorrhea (odds ratio: 0.89, 95% confidence interval: 0.40-1.95) as compared with cases performed without LDs. Subgroup analysis of only CSF leaks associated with anterior skull base resections (6 studies, 153 cases) also demonstrated that lumbar drainage did not significantly affect rates of successful repair (odds ratio: 2.67, 95% confidence interval: 0.64-11.10). Conclusions There is insufficient evidence to support that adjunctive lumbar drainage significantly reduces postoperative CSF leak recurrence in patients undergoing endoscopic CSF leak repair. Subgroup analysis examining only those patients whose CSF leaks were associated with anterior skull base resections demonstrated similar results. More level 1 and 2 studies are needed to further investigate the efficacy of LDs, particularly in the setting of patients at high risk for CSF leak recurrence.
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Affiliation(s)
- Omar H. Ahmed
- Department of Otolaryngology–Head and Neck Surgery, New York University, New York, New York, USA
| | - Sonya Marcus
- Department of Otolaryngology–Head and Neck Surgery, New York University, New York, New York, USA
| | - Jenna R. Tauber
- School of Medicine, New York University, New York, New York, USA
| | - Binhuan Wang
- Department of Population Health, Division of Biostatistics, New York University, New York, New York, USA
| | - Yixin Fang
- Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Richard A. Lebowitz
- Department of Otolaryngology–Head and Neck Surgery, New York University, New York, New York, USA
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Yabuki K, Sano D, Shiono O, Arai Y, Chiba Y, Tanabe T, Nishimura G, Takahashi M, Taguchi T, Kaneta T, Hata M, Oridate N. Surgery-based versus radiation-based treatment strategy for a high metabolic volume laryngeal cancer. Laryngoscope 2016; 127:862-867. [DOI: 10.1002/lary.26233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/12/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Kenichiro Yabuki
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Daisuke Sano
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Osamu Shiono
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Yasuhiro Arai
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Yoshihiro Chiba
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Teruhiko Tanabe
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Goshi Nishimura
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Takahide Taguchi
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
| | - Tomohiro Kaneta
- Department of Radiology; Yokohama City University School of Medicine; Yokohama Japan
| | - Masaharu Hata
- Department of Oncology; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Nobuhiko Oridate
- Department of Otorhinolaryngology, Head and Neck Surgery; Yokohama City University School of Medicine; Yokohama Japan
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Šifrer R, Aničin A, Pohar MP, Žargi M, Pukl P, Soklič T, Strojan P. Pharyngocutaneous fistula: the incidence and the risk factors. Eur Arch Otorhinolaryngol 2016; 273:3393-9. [DOI: 10.1007/s00405-016-3963-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/01/2016] [Indexed: 11/28/2022]
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Deniz M, Ciftci Z, Gultekin E. Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy. Surg Res Pract 2015; 2015:363640. [PMID: 26366434 PMCID: PMC4541018 DOI: 10.1155/2015/363640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/27/2015] [Indexed: 11/17/2022] Open
Abstract
Objectives. A pharyngocutaneous fistula (PCF) following total laryngectomy is associated with increased morbidity and severe life threatening complications. We aimed to review our experience with the PCF following total laryngectomy and determine the impact of previously reported risk factors on the development of PCF in our patients. Methods. The medical records of 20 patients who had a total laryngectomy operation were retrospectively analyzed. The association between the proposed risk factors and the incidence of the PCF was investigated. Results. Comparison of the suture techniques used for the closure of the pharynx (either continuous Cushing type or interrupted) yielded that primary interrupted sutures had a significantly higher incidence of PCF formation (p < 0.05). Although it was not statistically significant, diabetes mellitus was also associated with increased PCF formation (p > 0.05). No significant difference was observed between the PCF and non-PCF groups in terms of other proposed risk factors (p > 0.05). Conclusions. The main risk factor associated with PCF was found to be the type of pharyngeal closure technique. A vertical closure with a Cushing type continuous suture may be more successful than interrupted sutures in preventing a PCF.
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Affiliation(s)
- Mahmut Deniz
- Department of Otorhinolaryngology, School of Medicine, Namik Kemal University, 59100 Tekirdag, Turkey
| | - Zafer Ciftci
- Department of Otorhinolaryngology, School of Medicine, Namik Kemal University, 59100 Tekirdag, Turkey
| | - Erdogan Gultekin
- Department of Otorhinolaryngology, School of Medicine, Namik Kemal University, 59100 Tekirdag, Turkey
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