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Williamson A, Shah F, Benaran I, Paleri V. Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta-analysis. Laryngoscope 2024; 134:2991-3002. [PMID: 38238878 DOI: 10.1002/lary.31287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.2% after primary and flap-assisted closure respectively. We aim to better define the role of vascularized flaps after salvage laryngectomy by performing an updated review comparing the rate of PCF in those undergoing primary or vascularized flap-assisted closure. DATA SOURCES Pubmed/Medline, CINAHL, and CENTRAL. REVIEW METHODS An updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta-analysis of odds ratios (OR) and pooled proportions were conducted. RESULTS Literature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I2 = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I2 = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I2 = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I2 = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on-lay and patch closure compared to primary closure techniques. Network meta-analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure. CONCLUSION The updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap-assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 134:2991-3002, 2024.
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Affiliation(s)
- Andrew Williamson
- Department of Head and Neck Surgery, The Royal Marsden Hospital, International Centre for Recurrent Head and Neck Cancer (IReC), London, United Kingdom
- Institute for Cancer Research, London, United Kingdom
| | - Faizan Shah
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Irene Benaran
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Glasgow, United Kingdom
| | - Vinidh Paleri
- Department of Head and Neck Surgery, The Royal Marsden Hospital, International Centre for Recurrent Head and Neck Cancer (IReC), London, United Kingdom
- Institute for Cancer Research, London, United Kingdom
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2
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Coviello CM, Sheehan C, Hernandez DJ, Liou NE, Sandulache VC, Haskins AD, Sturgis EM, Huang AT. Outcome Comparison of Functional Laryngectomy for the Dysfunctional Larynx to Salvage Laryngectomy. Laryngoscope 2024; 134:222-227. [PMID: 37345670 DOI: 10.1002/lary.30844] [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: 03/07/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To compare functional outcomes of total laryngectomy (TL) with microvascular free tissue transfer (MVFTT) reconstruction in the treatment of dysfunctional larynx (DL) versus salvage therapy for locally recurrent disease in patients with a history of laryngeal squamous cell carcinoma (SCC). METHODS Retrospective review from a tertiary medical center between August 2015 and August 2022. RESULTS Sixty-nine patients underwent TL with MVFTT following primary laryngeal radiation or chemoradiation; 15 (22%) patients underwent functional laryngectomy (FL) and 54 (78%) underwent a salvage laryngectomy (SL). There were no total flap failures. Four (6%) patients developed a pharyngocutaneous fistula; one (7%) FL patient and 3 (6%) in the SL cohort. There was no significant difference in average hospital length of stay (LOS) between the cohorts (8.6 ± 3.0 days vs. 12.8 ± 10.1 days, p = 0.12). All patients (100%) in the FL cohort achieved a total oral diet compared to 41 (76%) in the SL cohort (p = 0.03). Two (13%) and 10 (19%) patients developed pharyngoesophageal stenosis in the FL and SL cohorts, respectively (p = 1.0). Nine (60%) and 23 (43%) patients in the FL and SL cohorts underwent tracheoesophageal puncture (TEP) placement, with 89% and 91% achieving fluency, respectively (p = 0.23). CONCLUSION Although the role of TL for the definitive treatment of laryngeal SCC has decreased over the past 30 years, organ-preservation protocols can impact speech, swallowing, and airway protection with life-threatening consequences. The use of elective FL with MVFTT for the treatment of DL results in similar or better functional outcomes compared to SL for recurrent disease. LEVEL OF EVIDENCE 3 Laryngoscope, 134:222-227, 2024.
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Affiliation(s)
- Caitlin M Coviello
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Cameron Sheehan
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - David J Hernandez
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - N Eddie Liou
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Vlad C Sandulache
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Angela D Haskins
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Erich M Sturgis
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Andrew T Huang
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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3
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De Virgilio A, Costantino A, Festa BM, Russo E, Malvezzi L, Pellini R, Colombo G, Spriano G, Mercante G, Ferreli F. Surgical prevention of pharyngocutaneous fistula in salvage total laryngectomy: a systematic review and network meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:5839-5849. [PMID: 35731297 DOI: 10.1007/s00405-022-07490-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/05/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the efficacy of different reconstructive techniques in preventing pharyngocutaneous fistula (PCF) after salvage total laryngectomy (STL). METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model according to the PRISMA-NMA guidelines. RESULTS A total of 1694 patients with a median age of 64 years (n = 1569, 95% CI: 62-66 years) were included. If compared to primary pharyngeal closure alone, only a pedicled flap onlay (PFO) showed a statistically significant reduction in PCF rate (OR: 0.35, CI: 0.20-0.61). PFO seemed to perform better than other treatments according to the rank probabilities test (39.9% chance of ranking first). CONCLUSIONS A pedicled flap placed with an overlay technique might be preferred over a patch reconstruction to prevent PCF after STL.
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Affiliation(s)
- Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy. .,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Giovanni Colombo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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4
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Bathula SS, Stern NA, Ross A, Patrick T, Talatala ER. Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience. Cureus 2021; 13:e18198. [PMID: 34722018 PMCID: PMC8544620 DOI: 10.7759/cureus.18198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the effectiveness of the pectoralis major myocutaneous (PMMC) flap in preventing pharyngocutaneous fistula (PCF) formation for salvage total laryngectomy patients. Study design Retrospective chart review of all post-surgical laryngectomy patients for a single surgeon. Methods Inclusion criteria were adult patients 18 years and older who were diagnosed with laryngeal cancer and treated with a salvage total laryngectomy. Exclusion criteria were any laryngectomy patient treated without the PMMC flap or those with incomplete medical records. Results A total of 31 patient charts were identified, and 16 remained after exclusion criteria. The patient age range was 42-71 years (mean = 58.19; SD = 8.093). Greater than 85% of patients had T3 and T4 laryngeal cancers. Without PCF group were 13 patients and with PCF group were only three patients. The mean hospital days in without PCF group were 9.54 and in with PCF group were 16.33. Conclusion In this single surgeon’s experience, PCF was prevented by using the PMMC flap in salvage total laryngectomy patients.
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Affiliation(s)
- Samba Siva Bathula
- Otolaryngology, Michigan State University/Detroit Medical Center, Detroit, USA
| | - Noah A Stern
- Otolaryngology, Detroit Medical Center, Detroit, USA
| | - Andrew Ross
- Otolaryngology - Head and Neck Surgery, Detroit Medical Center, Detroit, USA
| | - Tyler Patrick
- Otolaryngology, Detroit Medical Center, Detroit, USA
| | - Edward R Talatala
- Otolaryngology - Head and Neck Surgery, Meharry Medical College, Detroit, USA
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5
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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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Sanchez A, Frank E, Inman J, Wang W, Namin A, Ducic Y. Fistula Management in Head and Neck Cancer. Semin Plast Surg 2020; 34:299-304. [PMID: 33380917 PMCID: PMC7759424 DOI: 10.1055/s-0040-1721825] [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] [Indexed: 12/13/2022]
Abstract
Fistulas in head and neck cancer patients are a common and challenging issue. Despite their commonality, there is little consensus regarding optimal treatment strategies or in preventative measures that might be taken preoperatively. A general knowledge and understanding of what factors correlate with fistula formation can assist a surgeon in optimizing a patient for surgery, thus decreasing prevalence. In addition, surgical techniques can aid in both the prevention and treatment of fistulas once they form. This review details risk factors for fistula formation, the use of vascularized tissue as a preventative measure, conservative and nonconservative treatment of fistulas, and possible strategies to decrease the likelihood of their formation.
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Affiliation(s)
- Anthony Sanchez
- Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Ethan Frank
- Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Jared Inman
- Department of Otolaryngology – Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Arya Namin
- Department of Otolaryngology – Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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7
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Chen DW, Ellis MA, Horwich P, Sandulache VC, Liou NE, Hernandez DJ, Sturgis EM, Graboyes EM, Hornig JD, Day TA, Huang AT. Free Flap Inset Techniques in Salvage Laryngopharyngectomy Repair: Impact on Fistula Formation and Function. Laryngoscope 2020; 131:E875-E881. [PMID: 32833308 DOI: 10.1002/lary.28939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To characterize pharyngocutaneous fistula (PCF) rates and functional outcomes following microvascular free tissue transfer (MVFTT) reconstruction of salvage total laryngectomy (STL) with a review of two different flap inset techniques and a review of the literature. METHODS Retrospective review. RESULTS Review of the literature revealed 887 patients who underwent STL MVFTT from 14 references. Ninety-six STL MVFTTs were performed by the authors, with 36 (38%) patients undergoing multilayer fascial underlay (MLFU) closure and 60 (62%) a standard single layer closure (SLC). One (3%) PCF occurred in the MLFU group compared to 12 (20%) in the SLC cohort (P = .03). Postoperative gastrostomy (G)-tube dependence was lower following MLFU closure compared to SLC (25% vs. 57%, P < .01), whereas pharyngoesophageal stricture (PES) (28% vs. 38%), tracheoesophageal puncture (TEP) placement (42% vs. 42%), and TEP usage (87% vs. 88%) did not significantly differ (P > .05). Compared to pooled rates from the literature, patients who underwent a MLFU MVFTT inset technique demonstrated significantly lower PCF incidence (3% vs. 23%, P < .01) without significant differences in PES (28% vs 23%, P = .55), G-tube dependence (25% vs. 23%, P = .25), or TEP placement (42% vs. 59%, P = .09). CONCLUSION Despite MVFTT reconstruction after STL, G-tube dependence, PCF formation, and limitations of speaking rehabilitation (TEP) remain a significant issue. Modification of MVFTT inset may provide an opportunity to reduce PCF incidence without affecting other functional outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E875-E881, 2021.
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Affiliation(s)
- Diane W Chen
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mark A Ellis
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Peter Horwich
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Vlad C Sandulache
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Nelson E Liou
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - David J Hernandez
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Erich M Sturgis
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Joshua D Hornig
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Terry A Day
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Andrew T Huang
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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8
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Gonzalez-Orús Álvarez-Morujo R, Martinez Pascual P, Tucciarone M, Fernández Fernández M, Souviron Encabo R, Martinez Guirado T. Salvage total laryngectomy: is a flap necessary? Braz J Otorhinolaryngol 2020; 86:228-236. [PMID: 30683565 PMCID: PMC9422674 DOI: 10.1016/j.bjorl.2018.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/06/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. Objective Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. Methods We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. Results We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p = 0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p = 0.03) and large pharyngostomes (64.3% versus 0%, p = 0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p = 0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p = 0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. Conclusions Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.
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9
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Iglesias-Moreno MC, Sarrió-Solera P, López-Salcedo MA, Poch-Pérez-Botija A, Gómez-Serrano M, Gimeno-Hernández J, Poch-Broto J. Use of pectoralis major myofascial flap on the prevention of pharyngocutaneous fístula in salvage laryngectomy after chemoradiotherapy. Acta Otolaryngol 2019; 139:926-929. [PMID: 31430221 DOI: 10.1080/00016489.2019.1649721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Pharyngocutaneous fístula (PCF) is a major complication of salvage laryngectomies, mainly secondary to the effect of radiotherapy. Aims/objectives: Our main objective is to study the effect of pectoralis major myofascial flap (PMMF) on the prevention of PCF. Materials and methods: We studied all total laryngectomies (TL) performed between 2001 and 2018, noting the use of previous chemoradiation, the type of suture and the use of flaps. We recorded and compared the incidence of PCF in all groups. Results: A total of 146 patients were included, divided into a primary TL group (117 patients) and salvage TL (29 patients). PMMF was used in 62% of salvage TLs. The rates of PCF were 5.98% in primary TL and 17.2% in salvage procedures. Among the salvage TL group, in patients with pharyngeal closure alone, a PCF developed in 36.4% of cases, compared to 5.56% in the PMMF group. We found a similar rate of fistulae when comparing primary TL and salvage TL with PMMF, highlighting the protective effect of the flap. Conclusions and significance: The use of PMMF in salvage TL reduces the incidence of PCF, achieving a rate similar to that attained with primary TL.
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Affiliation(s)
| | - Pablo Sarrió-Solera
- Department of Otolaryngology – Head and Neck Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | | | | | - Manuel Gómez-Serrano
- Department of Otolaryngology – Head and Neck Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | - Jesus Gimeno-Hernández
- Department of Otolaryngology – Head and Neck Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | - Joaquin Poch-Broto
- Department of Otolaryngology – Head and Neck Surgery, Hospital Clinico San Carlos, Madrid, Spain
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10
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Formeister EJ, Sean Alemi A, El-Sayed I, George JR, Ha P, Daniel Knott P, Ryan WR, Seth R, Tamplen ML, Heaton CM. Shorter interval between radiation therapy and salvage laryngopharyngeal surgery increases complication rates following microvascular free tissue transfer. Am J Otolaryngol 2018; 39:548-552. [PMID: 29908709 DOI: 10.1016/j.amjoto.2018.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate how the interval between radiation and salvage surgery for advanced laryngeal cancer with free tissue transfer reconstruction influences complication rates. MATERIALS AND METHODS This is a retrospective series of 26 patients who underwent salvage laryngectomy or laryngopharyngectomy with vascularized free tissue reconstruction (anterolateral thigh or radial forearm) following radiation or chemoradiation between 2012 and 2017 at a single academic center. The primary outcome was incidence of postoperative complications, including pharyngocutaneous fistula. Secondary outcomes included the need for a second procedure, time to resumption of oral feeding, feeding tube dependence, and hospital length of stay. RESULTS Salvage surgery was performed for persistence (7/26, 27%), recurrence/new primary (12/26, 46%), and dysfunctional larynges (7/26, 27%). Twenty-two (85%) defects were reconstructed with an anterolateral thigh free flap and 4/26 with a radial forearm free flap (15%). There were no flap failures. There were significantly more complications in patients undergoing surgery within 12 months of completion of radiation therapy (7/12, 58%) versus those undergoing surgery after 12 months (1/14, 7%; p = .02). Patients experiencing complications more often required a second procedure (4/7 vs. 0/1; p = .02), experienced a longer delay to initiation of oral diet (61 vs. 21 days; p = .04), and stayed in the hospital longer (28 vs. 9 days; p = .01). CONCLUSIONS Shorter intervals between definitive radiation and salvage laryngopharyngeal surgery with free tissue reconstruction increases postoperative complications, hospital length of stay, and the likelihood of feeding tube dependence. Reconstructive surgeons can use these findings to help guide preoperative patient counseling and assess postoperative risk.
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Affiliation(s)
- Eric J Formeister
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - A Sean Alemi
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Ivan El-Sayed
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Jonathan R George
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Patrick Ha
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - P Daniel Knott
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - William R Ryan
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Rahul Seth
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Matthew L Tamplen
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Chase M Heaton
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA, USA.
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11
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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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Reconstruction after salvage laryngectomy. Oral Oncol 2017; 75:22-27. [DOI: 10.1016/j.oraloncology.2017.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/23/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022]
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13
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Graville DJ, Palmer AD, Chambers CM, Ottenstein L, Whalen B, Andersen PE, Wax MK, Cohen JI. Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer. Head Neck 2017; 39:2319-2328. [DOI: 10.1002/hed.24902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/29/2017] [Accepted: 06/28/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Donna J. Graville
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Andrew D. Palmer
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | | | | | - Breanne Whalen
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Peter E. Andersen
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Mark K. Wax
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
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14
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Crosetti E, Caracciolo A, Arrigoni G, Fantini M, Sprio AE, Berta GN, Succo G. Management of T4a Laryngeal Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Guimarães AV, Aires FT, Dedivitis RA, Kulcsar MAV, Ramos DM, Cernea CR, Brandão LG. Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review. Head Neck 2015; 38 Suppl 1:E2317-21. [DOI: 10.1002/hed.24248] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- André Vicente Guimarães
- Department of Head and Neck Surgery, Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - Felipe Toyama Aires
- Department of Head and Neck Surgery, Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - Rogério Aparecido Dedivitis
- Department of Head and Neck Surgery, Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | | | - Daniel Marin Ramos
- Department of Head and Neck Surgery; Cancer Institute of São Paulo ICESP; São Paulo Brazil
| | - Claudio Roberto Cernea
- Department of Head and Neck Surgery, Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - Lenine Garcia Brandão
- Department of Head and Neck Surgery, Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
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16
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Ménière's disease: the old and the new. The Journal of Laryngology & Otology 2014. [DOI: 10.1017/s0022215114000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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Paleri V, Drinnan M, van den Brekel MWM, Hinni ML, Bradley PJ, Wolf GT, de Bree R, Fagan JJ, Hamoir M, Strojan P, Rodrigo JP, Olsen KD, Pellitteri PK, Shaha AR, Genden EM, Silver CE, Suárez C, Takes RP, Rinaldo A, Ferlito A. Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014; 124:1848-53. [PMID: 24474684 DOI: 10.1002/lary.24619] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/13/2013] [Accepted: 01/27/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVES/HYPOTHESIS Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs and quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularized tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis. DATA SOURCES English language literature from 2004 to 2013 REVIEW METHODS: We searched the English language literature for articles published on the subject from 2004 to 2013. RESULTS Adequate data was available to identify pooled incidence rates from seven articles. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by one-third. CONCLUSION This pooled analysis suggests that there is a clear advantage in using vascularized tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair.
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Affiliation(s)
- Vinidh Paleri
- Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle upon Tyne, Nottingham, U.K
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