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Mandor EA, Ebada HA, El-Fattah AMA, Kamal E, Baz H, Tawfik A. Stapler versus conventional pharyngeal repair after total laryngectomy: a randomized clinical trial. Eur Arch Otorhinolaryngol 2024; 281:4273-4280. [PMID: 38739184 PMCID: PMC11266385 DOI: 10.1007/s00405-024-08696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES The aim of the current study was to evaluate the functional outcomes of stapler pharyngeal closure after total laryngectomy by the incidence of PCT and assessment of swallowing after surgery. In addition, the study aimed to evaluate the oncological outcomes in terms of patients' survival rates. METHODS This randomized clinical trial was conducted on 58 patients with advanced laryngeal carcinoma who underwent total laryngectomy. Patients were randomly assigned to two groups according to the method of pharyngeal repair after laryngectomy: manual closure group (n = 28), and stapler group (n = 30). Functional and oncological outcomes were assessed and compared. RESULTS The incidence of pharyngocutaneous fistula was significantly less in the stapler group. Additionally, operative time was significantly shorter and swallowing function was better in the stapler group compared to the manual group. There was no statistically significant difference between groups regarding survival rates. CONCLUSION The stapler is a reliable method for pharyngeal closure after total laryngectomy if the limits of its indications regarding the primary tumor are considered. Stapler closure decreases the incidence of PCF and decreases the surgical time. Good swallowing outcomes are achieved without compromising the oncological outcomes.
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Affiliation(s)
| | - Hisham Atef Ebada
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt.
| | | | - Elsharawy Kamal
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| | - Hemmat Baz
- Phoniatrics, Mansoura University, Mansoura, Egypt
| | - Ali Tawfik
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
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Giotakis AI, Potamianos S, Zachou Z, Giotakis EI, Kyrodimos E. Horizontal pharyngeal closure during total laryngectomy reduces rates of pharyngocutaneous fistula. Eur Arch Otorhinolaryngol 2024; 281:3179-3187. [PMID: 38551697 DOI: 10.1007/s00405-024-08593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/29/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Pharyngocutaneous fistula (PCF) is a possible complication following total laryngectomy (TL), with a mean incidence of 17%. We intended to investigate the effect of pharyngeal closure type during TL on the prevention of PCF. METHODS We retrospectively reviewed patients that underwent TL with a horizontal pharyngeal closure over a 10-year period. The frequency of PCF clinically, dysphagia, total oral diet, postoperative dilatation of the neopharynx and voice problems were tabulated. RESULTS Seventy-seven subjects underwent TL due to laryngeal tumor without pharyngeal extension. Of them, 45 underwent a salvage TL. PCF occurred in 1/77 subjects. The rest of the subjects (76/77) did not develop a PCF, neither in the early nor in the late postoperative phase. All subjects (15/77) that underwent implantation of a voice prosthesis were satisfied with their voice. No subject complained about dysphagia. Every subject achieved total oral diet. CONCLUSION The horizontal pharyngeal closure is a safe pharyngeal closure technique during TL, reduces PCF rates (< 2%), results in excellent voice rehabilitation and swallowing function, and can also be used during salvage TL instead of a major pectoral flap. This type of closure should be used only in selected patients with laryngeal disease without pharyngeal extension.
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Affiliation(s)
- Aris I Giotakis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece.
| | - Spyridon Potamianos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Zoi Zachou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Evangelos I Giotakis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
| | - Efthymios Kyrodimos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527, Athens, Greece
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The formulation of an enhanced recovery programme for patients undergoing laryngectomy. The Journal of Laryngology & Otology 2022; 136:848-860. [DOI: 10.1017/s0022215122000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveEnhanced recovery programmes have been widely adopted in other surgical disciplines but are not commonplace in head and neck surgery. The authors of this study created a pathway for post-operative laryngectomy patients.MethodA multidisciplinary working group reviewed the literature and agreed standards of care. A retrospective audit was conducted to measure current practice against our new pathway; after programme implementation our performance was reaudited in two prospective cycles, with an education programme and review after the first prospective cycle.ResultsStatistically significant improvement in performance was realised in catheter and surgical drain removal, opiate analgesia use, mobilisation, and timeliness of swallow assessment. The rate of hospital acquired pneumonia reduced from 23.1 to 9.5 per cent and length of stay reduced by a median of 5.2 days to 14.8 days (non-significant).ConclusionThe programme improved consistency of patient care across most areas that were measured. Improving patient stoma training needs to be prioritised.
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Semon Lecture: 'Laryngectomy Practice Based on Personal Research', Royal Society of Medicine, 5 November 2020, London, UK. The Journal of Laryngology & Otology 2021; 135:E3. [PMID: 34137368 DOI: 10.1017/s0022215121001511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
I wish to thank the Semon Committee for inviting me to deliver the 2020 Semon lecture. This is a very special honour, as is evidenced by the list of distinguished lecturers dating back to the inaugural lecture delivered at University College London in 1913. I am not the first South African to deliver the Semon lecture, having been preceded by my previous chairman Sean Sellars in 1993, and by Jack Gluckman in 2001, who was South African raised and educated and who subsequently became the chairman of otolaryngology in Cincinnati, USA.
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Park J, Chang C, Kwon D. Use of fibrin adhesive for preventing pharyngocutaneous fistula in total laryngectomy. Am J Otolaryngol 2020; 41:102674. [PMID: 32836041 DOI: 10.1016/j.amjoto.2020.102674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Minimizing pharyngocutaneous fistula after total laryngectomy is a perpetual focus for head and neck surgeons. Multiple intrinsic and extrinsic factors have been implicated in the wound healing process. Activated fibrin glue uniquely promotes healing as a tissue adhesive as well as a biochemical growth factor. METHODS We present a pilot case series of total laryngectomy with simple pharyngeal closure with a single surgeon. Fibrin tissue adhesive was incorporated in all patients along with standardized pre-operative, operative, and post-operative care. Outcomes measured included pharyngocutaneous fistula rate, perioperative complications, and other wound complications as well as long term swallowing function and voice rehab outcomes. We also present a review of the literature for the theoretical basis of using fibrin glue as well as other similar applications. RESULTS Fibrin tissue adhesive was successfully used in 18 consecutive patients undergoing total laryngectomy and pharyngoplasty. Despite the presence of a variety of wound healing risk factors including prior radiation and tobacco use, there were no pharyngocutaneous fistulas or other significant wound problems. No locoregional or free tissue overlay flap was done. CONCLUSION Fibrin tissue glue is a readily available, easily applied, and cost-effective adjunct that may reduce pharyngocutaneous fistula.
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Platelet-rich fibrin: an autologous biomaterial for healing assistance of pharyngeal repair in total laryngectomy. Eur Arch Otorhinolaryngol 2020; 278:463-470. [PMID: 33009930 DOI: 10.1007/s00405-020-06404-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the potential role of platelet-rich fibrin (PRF) application on the pharyngeal repair on decreasing the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy. METHODS This randomized controlled clinical trial was conducted on 67 patients with advanced laryngeal carcinoma who underwent total laryngectomy, over 2 years in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: PRF group (n = 35) and control group (n = 32). Risk factors for development of PCF as well as the incidence of PCF were studied in both groups. RESULTS There was no statistically significant difference between groups regarding demographic data, medical comorbidities, basal hemoglobin and albumin levels, data related to the tumor (location, grade and TNM staging) and surgical details (preoperative tracheotomy and neck dissection). However, regarding the incidence of PCF, there was a statistically significant difference between groups as shown in Table 2. PCF was detected in 2/35 patients (5.7%) in the PRF group and in 10/32 patients (31.3%) in the control group (p = 0.004). CONCLUSION PRF application on the pharyngeal repair after total laryngectomy enhances the healing process and consequently decreases the incidence of PCF.
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Carsuzaa F, Capitaine AL, Ferrié JC, Apert V, Tonnerre D, Frasca D, Dufour X. Pharyngocutaneous fistulas after total laryngectomy or pharyngolaryngectomy: Place of video-fluoroscopic swallowing study. Head Neck 2020; 42:3638-3646. [PMID: 32864848 DOI: 10.1002/hed.26429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/18/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Specify place of video-fluoroscopic swallowing study (VFS) in the decision of oral refeeding after total pharyngolaryngectomy. METHODS At postoperative day 7, a blue dye testing was performed. If negative, a VFS was performed looking for a blind fistula. If this exam was negative, oral refeeding was started, but if a blind fistula was observed, cervical compression bandage was performed. RESULTS In 186 patients, a VFS was performed for 142 patients with negative blue dye testing. It was negative for 98 patients (69%) and positive for 44 patients (31%) (blind fistula). Patients had a probability of 7.1% to have a secondary pharyngocutaneous fistula (PCF) if the VFS was negative, and 15.9% if it was positive. No risk factor for the development of a secondary PCF or a blind fistula emerged from our analysis. CONCLUSION VFS should be performed before any oral refeeding in all patients operated with a total pharyngolaryngectomy.
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Affiliation(s)
- Florent Carsuzaa
- Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | | | - Jean-Claude Ferrié
- Radiology and Diagnostic Imaging, University Hospital of Poitiers, Poitiers, France
| | - Vincent Apert
- Head and Neck Surgery, Hospital of Niort, Niort, France
| | - Denis Tonnerre
- Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Denis Frasca
- Anesthesiology, University Hospital of Poitiers, Poitiers, France.,Data Biostatistics Department, University Hospital of Poitiers, Poitiers, France.,INSERM UMR-1246, Universities of Nantes and Tours, Tours, France
| | - Xavier Dufour
- Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France.,Laboratoire Inflammation Tissus Epitheliaux et Cytokines EA4331, University of Poitiers, Poitiers, France
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Worrall DM, Tanella A, DeMaria S, Miles BA. Anesthesia and Enhanced Recovery After Head and Neck Surgery. Otolaryngol Clin North Am 2019; 52:1095-1114. [PMID: 31551127 DOI: 10.1016/j.otc.2019.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Enhanced recovery protocols have been developed from gastrointestinal, colorectal, and thoracic surgery populations. The basic tenets of head and neck enhanced recovery are: a multidisciplinary team working around the patient, preoperative carbohydrate loading, multimodal analgesia, early mobilization and oral feeding, and frequent reassessment and auditing of protocols to improve patient outcomes. The implementation of enhanced recovery protocols across surgical populations appear to decrease length of stay, reduce cost, and improve patient satisfaction without sacrificing patient quality of care or changing readmission rates. This article examines evidence-based enhanced recovery interventions and tailors them to a major head and neck surgery population.
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Affiliation(s)
- Douglas M Worrall
- Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1189, New York, NY 10029, USA
| | - Anthony Tanella
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - Samuel DeMaria
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1010, New York, NY 10029, USA
| | - Brett A Miles
- Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1189, New York, NY 10029, USA.
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Skinner M, Tritz D, Farahani C, Ross A, Hamilton T, Vassar M. The fragility of statistically significant results in otolaryngology randomized trials. Am J Otolaryngol 2019; 40:61-66. [PMID: 30472124 DOI: 10.1016/j.amjoto.2018.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The American Academy of Otolaryngology-Head and Neck Surgery regards randomized controlled trials as class A evidence. A novel method to determine the robustness of outcomes in trials is the fragility index. This index represents the number of patients whose status would have to change from a non-event to an event to make a statistically significant result non-significant. METHODS Investigators included otolaryngology journals listed in the top 10 of one or both of Google Scholar Metrics and Clarivate Analytics' Journal rankings. For inclusion, a randomized controlled trial needed to report a one-to-one random assignment of participants to condition, contain two parallel arms or have used a two-by-two factorial design, and report at least one statistically significant dichotomous outcome. RESULTS Sixty-nine trials met inclusion criteria. The median fragility index was three events (interquartile range 1-7.5). Median sample size was 72 (interquartile range 50-102.5). Modest correlations were observed between fragility index and total sample size (r = 0.27) and fragility index and event rate (r = 0.46). Investigators found no correlation between fragility index and impact factor or Science Citation Index. In 39% (27/69) of trials, the number lost to follow-up was equal to or greater than the fragility index. CONCLUSION A median fragility index of 3 indicates that three people, on average, are needed to alter the outcomes in otolaryngology trials. This indicates that the results of two-group randomized controlled trials reporting binary endpoints published in otolaryngology journals may frequently be fragile.
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Affiliation(s)
- Mason Skinner
- Oklahoma State University Medical Center, 744 W 9th St, Tulsa, OK 74127, United States of America
| | - Daniel Tritz
- Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK 74107, United States of America
| | - Clayton Farahani
- Oklahoma State University Medical Center, 744 W 9th St, Tulsa, OK 74127, United States of America
| | - Andrew Ross
- Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK 74107, United States of America.
| | - Tom Hamilton
- Oklahoma State University Medical Center, 744 W 9th St, Tulsa, OK 74127, United States of America
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK 74107, United States of America
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10
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Early Oral Feeding Following Primary Total Laryngectomy. DIFFICULT DECISIONS IN SURGERY: AN EVIDENCE-BASED APPROACH 2019. [DOI: 10.1007/978-3-030-15123-2_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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11
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Stephenson KA, Pandey S, Lubbe DE, Fagan JJ. Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy. Head Neck 2018; 40:2606-2611. [DOI: 10.1002/hed.25334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 01/13/2018] [Accepted: 04/19/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Sarita Pandey
- Division of OtorhinolaryngologyFrere Hospital East London South Africa
| | - Darlene E. Lubbe
- Division of Otorhinolaryngology, Faculty of Health SciencesUniversity of Cape Town Cape Town South Africa
| | - Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health SciencesUniversity of Cape Town Cape Town South Africa
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12
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Haidar YM, Kuan EC, Verma SP, Goddard JA, Armstrong WB, Tjoa T. Free Flap Versus Pedicled Flap Reconstruction of Laryngopharyngeal Defects: A 10-Year National Surgical Quality Improvement Program Analysis. Laryngoscope 2018; 129:105-112. [PMID: 30151829 DOI: 10.1002/lary.27455] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/03/2018] [Accepted: 06/25/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Large defects after total laryngectomy (TL) and total laryngopharyngectomy (TLP) often benefit from free flap (FF) or pedicled flap (PF) reconstruction to maintain continuity of the aerodigestive tract, protect great vessels, or reinforce pharyngeal closure. Although both techniques are commonly used, no consensus exists as to which results in fewer complications. The goal of this study was to determine if 30-day morbidity/mortality outcomes differ between PF and FF reconstruction in patients undergoing TL/TLP. STUDY DESIGN Retrospective cohort study. METHODS Patients were analyzed who underwent TL/TLP with reconstruction using records from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2015). RESULTS A total of 347 patients were included; 204 received FF reconstruction, whereas 143 received PF reconstruction. FF reconstruction was more commonly used with TLP defects (P = .001). The total operative time in the FF (590 ± 140 minutes) was longer than the PF (441 ± 125 minutes) group (P < .0001). There was a higher rate of postoperative transfusions in those undergoing FF reconstruction (P = .022). There was no significant difference in complication rates among TLP patients. Among TL patients only, FF reconstruction had a higher association with wound infections than PFs (P = .040). On multivariate analysis, low hematocrit was associated with complications (P = .031). Age (P = .031) and congestive heart failure exacerbation (P < .001) were associated with increased hospital stay. Overall, there were no differences in readmissions, reoperations, or deaths between the groups. CONCLUSIONS Reported complication rates after TL/TLP remain high, despite widespread usage of vascularized flaps in reconstruction. This comparison reveals no significant difference in postoperative complications between patients who received PF and FF laryngopharyngeal reconstruction. LEVEL OF EVIDENCE 4 Laryngoscope, 129:105-112, 2019.
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Affiliation(s)
- Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
| | - Julie A Goddard
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Colorado, Denver, Colorado, U.S.A
| | - William B Armstrong
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California
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Vasani SS, Youssef D, Lin C, Wellham A, Hodge R. Defining the low-risk salvage laryngectomy-A single-center retrospective analysis of pharyngocutaneous fistula. Laryngoscope Investig Otolaryngol 2018; 3:115-120. [PMID: 29721544 PMCID: PMC5915824 DOI: 10.1002/lio2.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/03/2018] [Indexed: 11/07/2022] Open
Abstract
Objectives Salvage total laryngectomies (STL) are not a homogeneous group. Most will fall into two groups: i) Patients with previous AJCC stage I/II larynx cancer who have had radiotherapy to the larynx only (STL‐LOR), or ii) Patients who have had previous AJCC stage III/IV larynx cancer and subsequent radiotherapy to the larynx and draining nodal basins with concurrent cisplatin chemotherapy (STL‐CRT). We aimed to compare PCF rates following STL in these two groups. Methods A retrospective review of the department's cohort between January 2010 and August 2015 was conducted. Results Seventy‐seven patients underwent total laryngectomy for larynx cancer between January 2010 and August 2015. There were 10 post‐laryngectomy fistulas (13.0%). Three of these occurred in the 38 patients undergoing primary total laryngectomy (PTL), and seven in the 39 patients undergoing STL, rates of 7.9% and 17.9%, respectively. Twenty‐two patients had received radiation to the larynx alone without chemotherapy (STL‐LOR) for initial Stage I/II disease. Eleven patients had received laryngeal and neck irradiation plus cisplatin chemotherapy (STL‐CRT) for initial stage III/IV disease. Of the 22 STL‐LOR patients, two developed PCF (9.1%). Of the 11 STL‐CRT patients, five developed PCF. There was no difference in the rate of PCF between PTL and STL‐LOR. There was a statistically significant increase in PCF in STL‐CRT versus PTL (p = .009) and in PCF in STL‐CRT versus STL‐LOR (p = .027). Conclusion Salvage laryngectomies are often treated as a homogenous group. We demonstrate that PCF rates vary significantly depending on preoperative radiation fields and the use of chemotherapy. Level of Evidence 2b.
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Affiliation(s)
- Sarju S. Vasani
- Department of Otolaryngology, Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Daniel Youssef
- Department of Otolaryngology, Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Charles Lin
- Department of Oncology, Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Annabelle Wellham
- Department of Otolaryngology, Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Robert Hodge
- Department of Otolaryngology, Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
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14
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Noel CW, McMullen C, Yao C, Monteiro E, Goldstein DP, Eskander A, de Almeida JR. The fragility of statistically significant findings from randomized trials in head and neck surgery. Laryngoscope 2018; 128:2094-2100. [DOI: 10.1002/lary.27183] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Christopher W. Noel
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Caitlin McMullen
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Christopher Yao
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Hospital; Toronto Ontario Canada
| | - David P. Goldstein
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre; University Health Network; Toronto Ontario Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre; Odette Cancer Centre; Toronto Ontario Canada
| | - John R. de Almeida
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre; University Health Network; Toronto Ontario Canada
- Institute of Health Policy Management and Evaluation; University of Toronto; Toronto Ontario Canada
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15
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Langerman A, Mitchell M. Nuanced Reporting of Fistulas in Laryngectomy Studies. Otolaryngol Head Neck Surg 2018; 159:213-214. [PMID: 29661091 DOI: 10.1177/0194599818770617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pharyngocutaneous fistula is an important complication of laryngectomy and can vary significantly in severity. Many authors have advocated for the use of vascularized flaps (eg, pectoralis major) to reduce the risk of fistula. Prevention of small, self-limited fistulas may not be worth the morbidity of a vascularized flap in some cases. More nuanced analysis of fistula outcomes, stratified by severity, may enable better surgeon-patient decision making regarding the use of vascularized flaps in laryngectomy.
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Affiliation(s)
- Alexander Langerman
- 1 Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Margaret Mitchell
- 2 School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
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16
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Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge about its management. Am J Otolaryngol 2018; 39:127-132. [PMID: 29307652 DOI: 10.1016/j.amjoto.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE Investigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients. MATERIALS AND METHODS Behavioral and 24-hour pH- and impedance-monitoring data were prospectively analyzed for 25 laryngectomised patients with no previous history of GER in outpateints' setting. Reflux detected was characterized as either acid, weakly acidic or nonacid. Proximal reflux was found at 15cm above the LES. RESULTS 40% of patients presented a pathological number of reflux episodes in the upright position (p<0.0001); 9 of them presented a pathologic bolus exposure time. Bolus exposure at the proximal sphincter was one fourth-fold lower than 5cm above the LES (p=0.3593). There was a prevalence of acid reflux at both sphincters (p<0.0001); liquid reflux was prevalent at the LES (p=0.003) and mixed reflux at the UES (p=0.0001). Median REs was higher than time acid exposure (p=0.0013). CONCLUSIONS Pre- and post-surgical reflux investigation could identify preexisting reflux severity and screen potential high-risk cancer patients for postoperative complications. This might allow the early onset of acid suppressive therapy in presence of pathologic findings in high-complication risk cancer patients.
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Walton B, Vellucci J, Patel PB, Jennings K, McCammon S, Underbrink MP. Post-Laryngectomy stricture and pharyngocutaneous fistula: Review of techniques in primary pharyngeal reconstruction in laryngectomy. Clin Otolaryngol 2017; 43:109-116. [PMID: 28544550 DOI: 10.1111/coa.12905] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy. STUDY DESIGN Retrospective Chart Review. METHODS We retrospectively reviewed a total of 151 patients over a 20-year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture postoperatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modelling, we performed univariate and multivariate analyses of our data. RESULTS The overall PCF and post-laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (P=.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (P=.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, P=.033, vertical, P=.037), while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (P=.63). CONCLUSION Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.
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Affiliation(s)
- B Walton
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - J Vellucci
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - P B Patel
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - K Jennings
- Department of Epidemiology and Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - S McCammon
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - M P Underbrink
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
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Bearelly S, Heaton CM, Seth R, Daniel Knott P. Laryngopharyngeal Repair in Salvage Laryngectomy. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0125-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Parzefall T, Wolf A, Czeiger S, Frei K, Formanek M, Erovic BM. Effect of postoperative use of diclofenac on pharyngocutaneous fistula development after primary total laryngopharyngectomy: Results of a single-center retrospective study. Head Neck 2015; 38 Suppl 1:E1515-20. [DOI: 10.1002/hed.24271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/13/2015] [Accepted: 09/13/2015] [Indexed: 12/26/2022] Open
Affiliation(s)
- Thomas Parzefall
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Axel Wolf
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Shelly Czeiger
- Department of Nuclear and Developmental Biology; Medical University of Vienna; Vienna Austria
| | - Klemens Frei
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Michael Formanek
- Department of Otolaryngology - Head and Neck Surgery; Hospital of St. John of God; Vienna Austria
| | - Boban M. Erovic
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
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