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Hou N, Lv D, Xu X, Lu Y, Li J, Ma R, Tang Y, Zheng Y. Development of a decellularized hypopharynx with vascular pedicle scaffold for use in reconstructing hypopharynx. Artif Organs 2022; 46:1268-1280. [PMID: 35191556 DOI: 10.1111/aor.14214] [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: 12/03/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypopharynx reconstruction after hypopharyngectomy is still a great challenge. Perfusion decellularization is for extracellular matrix (ECM) scaffolding and had been used in organ reconstruction. Our study aimed to prepare an acellular, natural, three-dimensional biological hypopharynx with vascular pedicle scaffold as the substitute materials to reconstruct hypopharynx. RESULT Scanning electron microscope and histology staining showed that the decellularized hypopharynx with vascular pedicle scaffold retained intact native anatomical ECM structure. Myoblasts were observed on the recellularized scaffolds with bone marrow mesenchymal stem cells induced by 5-azacytidine implanted in the rabbit greater omentum by immunohistochemical analysis. CONCLUSION The decellularized hypopharynx with vascular pedicle scaffold prepared by detergent perfusion in our study has a potential to be an alternative material to pharynx reconstruction.
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Affiliation(s)
- Nan Hou
- Department of Otorhinolaryngology Head and Neck Surgery, Clinical Medical College and The First Affiliated Hospital, Chengdu Medical College, Chengdu City, China
| | - Die Lv
- Department of Otorhinolaryngology Head and Neck Surgery, Clinical Medical College and The First Affiliated Hospital, Chengdu Medical College, Chengdu City, China.,Department of Otorhinolaryngology Head and Neck Surgery, Renshou People Hospital, Chengdu City, China
| | - Xiaoli Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Clinical Medical College and The First Affiliated Hospital, Chengdu Medical College, Chengdu City, China
| | - Yanqing Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Clinical Medical College and The First Affiliated Hospital, Chengdu Medical College, Chengdu City, China
| | - Jingzhi Li
- Department of Otorhinolaryngology Head and Neck Surgery, Clinical Medical College and The First Affiliated Hospital, Chengdu Medical College, Chengdu City, China
| | - Ruina Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an City, China
| | - Ying Tang
- Department of Otorhinolaryngology Head and Neck Surgery, Clinical Medical College and The First Affiliated Hospital, Chengdu Medical College, Chengdu City, China
| | - Yun Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu City, China
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Nutritional predictors of pharyngocutaneous fistula after total laryngectomy: A multivariate analytic study in a single institution. Auris Nasus Larynx 2021; 49:454-459. [PMID: 34610880 DOI: 10.1016/j.anl.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/19/2021] [Accepted: 09/18/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate, through multivariate analysis, the configuration of nutritional predictors that impact the development pharyngocutaneous fistula (PCF) after total laryngectomy. METHODS A retrospective cohort study carried out on 203 consecutive patients with laryngeal squamous cell carcinoma who underwent total laryngectomy with neck dissection between June 2015 and June 2020. Patients with risk factors for PCF formation, other than malnutrition, were excluded to eliminate the potential impact of that risk factors on PCF formation and to make the study group homogenous. Five parameters were evaluated including preoperative serum prealbumin, albumin and transferrin levels, Body Mass Index (BMI) and Malnutrition Screening Tool (MST). RESULTS Univariate analysis revealed that preoperative prealbumin, albumin and transferrin levels significantly correlated with PCF development. Multivariate logistic regression analysis revealed that preoperative prealbumin level was the best independent nutritional predictor of PCF (P value <0.001, odd ratio 11.951 [95% CI 3.686-38.749]) followed by preoperative albumin (P value 0.006, odd ratio 3.985 [95% CI 1.485- 10.694]). CONCLUSION Preoperative prealbumin level is considered the best independent nutritional predictor of PCF. It should be used to evaluate the nutritional status of patients undergoing total laryngectomy and hence their need for nutritional support.
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Cinamon U, Levy D, Sokolov M, Hayat H, Roth Y. Total Laryngectomy as a Palliative Procedure for a Patient with Advanced Laryngeal and Colon Cancers: Dilemmas. J Palliat Care 2019. [DOI: 10.1177/082585970602200411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Udi Cinamon
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center and Tel-Aviv University, Sackler School of Medicine, Holon, Israel
| | - Dalia Levy
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center and Tel-Aviv University, Sackler School of Medicine, Holon, Israel
| | - Maxim Sokolov
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center and Tel-Aviv University, Sackler School of Medicine, Holon, Israel
| | - Henri Hayat
- Department of Oncology, Edith Wolfson Medical Center and Tel-Aviv University, Sackler School of Medicine, Holon, Israel
| | - Yehudah Roth
- Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center and Tel-Aviv University, Sackler School of Medicine, Holon, Israel, and Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hoesli R, Brennan JR, Rosko AJ, Birkeland AC, Malloy KM, Moyer JS, Prince MEP, Shuman AG, Chinn SB, Stucken CL, Casper KA, Spector ME. Intraoperative Fluorescent Angiography Predicts Pharyngocutaneous Fistula After Salvage Laryngectomy. Ann Surg Oncol 2019; 26:1320-1325. [PMID: 30805812 DOI: 10.1245/s10434-019-07262-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Technology to assess tissue perfusion is exciting with translational potential, although data supporting its clinical applications have been lagging. Patients who have undergone radiation are at particular risk of poor tissue perfusion and would benefit from this expanding technology. We designed a prospective clinical trial using intraoperative indocyanine green angiography to evaluate for wound-healing complications in patients undergoing salvage laryngectomy after radiation failure. PATIENTS AND METHODS This prospective trial included patients undergoing salvage laryngectomy at a National Cancer Institute-designated tertiary cancer center between 2016 and 2018. After tumor extirpation and prior to reconstruction, 10 mg indocyanine green dye was infused and the fluorescence (FHYPO) and ingress rate of the pharyngeal mucosa recorded. The primary outcome measure was formation of a pharyngocutaneous fistula (PCF). RESULTS Patients who developed a PCF had significantly lower FHYPO (87 vs 172, p < 0.001) and ingress rates (6.7 vs 15.8, p = 0.043) compared with those who did not develop a fistula. There were no fistulas in patients with FHYPO > 150 (n = 21) or ingress > 15 (n = 15). There was a 50% fistula rate in patients with FHYPO ≤ 103 (n = 10) and ingress rate ≤ 6 (n = 6). CONCLUSIONS Intraoperative indocyanine green angiography can assess hypoperfusion in patients and predict risk of PCFs after salvage laryngectomy, and can thus intraoperatively risk-stratify patients for postoperative wound-healing complications.
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Affiliation(s)
- Rebecca Hoesli
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
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Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach. Head Neck 2018; 41:16-29. [DOI: 10.1002/hed.25192] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/03/2018] [Accepted: 03/02/2018] [Indexed: 11/08/2022] Open
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Wolber P, Schwarz D, Balk M, Luckscheiter N, Sommer C, Gostian AO. Pharyngeal fistulas after total laryngectomy with and without tracheostoma plasty according to Herrmann. Eur Arch Otorhinolaryngol 2018; 275:1281-1287. [PMID: 29574599 DOI: 10.1007/s00405-018-4948-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Pharyngeal fistula (PF) is one of the most common complications after total laryngectomy (TL). The tracheostoma plasty technique according to Herrmann (TPH) represents an alternative surgical technique to shape the tracheostoma. The aim of this study was to determine whether the performance of a TPH affects the incidence of PF after TL. A secondary aim was to identify potential risk factors for the development of PF with regard to TPH. METHODS Retrospective evaluation of records of 151 consecutive patients at two tertiary care centers with regard to the occurrence and risk factors of PF after TL with and without TPH. RESULTS 60 patients with TPH and 91 patients without TPH contributed to the results. The overall incidence of PF was 21.2% (32 out of 151). 23.3% (14 out of 60) of patients with TPH and 19.8% (18 of 91) of patients without TPH developed a PF (p = 0.91). Binary logistic regression analysis revealed significant influence of salvage surgery on the risk to develop PF (odds ratio = 2.9; 95% CI 1.16-7.23; p = 0.026). The occurrence of PF was not significantly influenced by any other investigated factors including performance of TPH. CONCLUSIONS Performance of TPH after TL does not increase the incidence of PF. Thus, TPH can be considered as a safe alternative surgical technique for the shaping of the tracheostoma following TL.
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Affiliation(s)
- Philipp Wolber
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne, 50924, Cologne, Germany.
| | - David Schwarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne, 50924, Cologne, Germany
| | - Matthias Balk
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne, 50924, Cologne, Germany
| | - Nicola Luckscheiter
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne, 50924, Cologne, Germany
| | - Claudia Sommer
- Department of Otolaryngology, Staedt. Kliniken Neuss, Neuss, Germany
| | - Antoniu-Oreste Gostian
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Cologne, 50924, Cologne, Germany
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Rosko AJ, Birkeland AC, Bellile E, Kovatch KJ, Miller AL, Jaffe CC, Shuman AG, Chinn SB, Stucken CL, Malloy KM, Moyer JS, Casper KA, Prince MEP, Bradford CR, Wolf GT, Chepeha DB, Spector ME. Hypothyroidism and Wound Healing After Salvage Laryngectomy. Ann Surg Oncol 2017; 25:1288-1295. [PMID: 29264671 DOI: 10.1245/s10434-017-6278-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients undergoing salvage laryngectomy are predisposed to radiation-induced hypothyroidism and impaired wound healing secondary to the tissue effects of prior treatment. The impact of hypothyroidism on postoperative wound healing is not established. METHODS A single-institution retrospective case series was performed. The inclusion criteria specified preoperatively euthyroid adults who underwent salvage laryngectomy with concurrent neck dissection between 1997 and 2015 for persistent or recurrent laryngeal squamous cell carcinoma after radiation or chemoradiation therapy (n = 182). The principal explanatory variable was postoperative hypothyroidism, defined as thyroid-stimulating hormone (TSH) higher than 5.5 mIU/L. The primary end points of the study were pharyngocutaneous fistulas and wounds requiring reoperation. Multivariate analysis was performed. RESULTS The fistula rate was 47% among hypothyroid patients versus 23% among euthyroid patients. In the multivariate analysis, the patients who experienced hypothyroidism in the postoperative period had a 3.6-fold greater risk of fistula [95% confidence interval (CI) 1.8-7.1; p = 0.0002]. The hypothyroid patients had an 11.4-fold greater risk for a required reoperation (24.4 vs 5.4%) than the euthyroid patients (95% CI 2.6-49.9; p = 0.001). The risk for fistula (p = 0.003) and reoperation (p = 0.001) increased with increasing TSH. This corresponds to an approximate 12.5% incremental increase in the absolute risk for fistula and a 10% increase in the absolute risk for reoperation with each doubling of the TSH. CONCLUSION Postoperative hypothyroidism independently predicts postoperative wound-healing complications. The association of hypothyroidism with fistula formation may yield opportunities to modulate wound healing with thyroid supplementation or to provide a biomarker of wound progression.
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Affiliation(s)
- Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Ashley L Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Craig C Jaffe
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto Health System, Toronto, ON, Canada
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
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Di Palma LDV, Mello GFDSE, Granados CL, Glória RD, Dalbem CS, Cruz RLD, Ayres ACM, Lisboa RSC, Pelosi AD, Ferreira MA, Mansur GR, Silva SGD, Ribeiro TCD, Dias FL. Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients. Endosc Int Open 2017; 5:E630-E634. [PMID: 28691045 PMCID: PMC5500110 DOI: 10.1055/s-0043-106581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/02/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Performing a percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients can be challenging because of the presence of trismus, pharyngeal obstruction by tumor, and pharyngoesophageal strictures or fistula. Pharyngocutaneous fistula (PCF) is a major postoperative concern in patients submitted to total laryngectomy (TL). In the medical literature to date, the cervical fistula has been used as an access to PEG in only four reports. The aim of this study was to evaluate the safety of cervical fistula for insertion of a PEG tube. PATIENTS AND METHODS Retrospective study at a single tertiary referral center, regarding the technical feasibility, safety and outcomes of a PEG tube introduced by a cervical fistula in HNC patients with obstructive lesions of the oropharynx. RESULTS The procedure was technically successful in all 21 patients. A PEG tube was used for a minimum of 1 month and a maximum of 120 months. Twelve patients died while using the PEG tube, 8 had it taken out because it was no longer needed, and only 1 had the tube still in use. Adverse events occurred in 8 patients: granuloma (19 %), dermatitis (9.5 %), accidental late removal of the tube (9.5 %), periprocedural gastric wall hematoma (9.5 %), peristomal wound infection (4.7 %), buried bumper syndrome (4.7 %), and traumatic gastric ulcer (4.7 %). CONCLUSION A postoperative cervical fistula can successfully work as a reliable and safe access for a PEG tube procedure in HNC patients, avoiding unnecessary surgery and reducing costs.
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Affiliation(s)
| | - Gustavo Francisco de Souza e Mello
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil,Corresponding author Gustavo Francisco de Souza e Mello, MD, PhD Department of Digestive EndoscopyCancer Hospital IBrazilian National Cancer InstitutePraça Cruz Vermelha 23Rio de Janeiro – RJ, CEP 20230-130
| | - Cindy Lis Granados
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Ricardo Dardengo Glória
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Caroline Sauter Dalbem
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Rolantre Lopes da Cruz
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Ana Carolina Maron Ayres
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Renata Sofia Camara Lisboa
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Alexandre Dias Pelosi
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Maria Aparecida Ferreira
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Gilberto Reynaldo Mansur
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Simone Guaraldi da Silva
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | | | - Fernando Luiz Dias
- Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
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Timmermans AJ, Lansaat L, Theunissen EAR, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. Predictive factors for pharyngocutaneous fistulization after total laryngectomy. Ann Otol Rhinol Laryngol 2014; 123:153-61. [PMID: 24633941 DOI: 10.1177/0003489414522972] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Postoperative complications, especially pharyngocutaneous fistulization (PCF), are more frequent after total laryngectomy (TL) performed for salvage after (chemo)radiotherapy than after primary TL. The aim of this study was to identify the incidence of PCF, predictive factors for PCF, and the relationship of PCF to survival. METHODS We performed a retrospective chart review of 217 consecutive patients treated with TL between 2000 and 2010. Univariate and multivariable analysis with logistic regression was used to identify factors associated with PCF. We used a Kaplan-Meier survival analysis. RESULTS The overall incidence of PCF was 26.3% (57 of 217 cases). The incidence of PCF after primary TL was 17.1% (12 of 70), that after salvage TL was 25.5% (25 of 98), that after TLE for a second primary was 37.5% (9 of 24), and that after TL for a dysfunctional larynx was 44.0% (11 of 25). The predictive factors for PCF were hypopharynx cancer (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.74 to 7.71; P = .001), an albumin level of less than 40 g/L (OR, 2.20; 95% CI, 1.12 to 4.33; P = .022), previous chemoradiotherapy (OR, 3.38; 95% CI, 1.34 to 8.52; P = .010), more-extended pharyngeal resection (P = .001), and pharynx reconstruction (P = .002). The median duration of survival was 30 months (95% CI, 17.5 to 42.5); the 2-year overall survival rate was 54%. The median duration of survival of patients with PCF was 23 months (95% CI, 9.4 to 36.6), and that of those without PCF was 31 months (95% CI, 15.0 to 47.0; P = .421). The 2-year overall survival rate was 48% in patients with PCF and 57% in those without PCF (P = .290). CONCLUSIONS Incidence of PCF after TL is significantly higher in patients with hypopharynx cancer, previous chemoradiotherapy, a low albumin level, more-extended pharyngeal resection, or pharynx reconstruction. The occurrence of PCF does not influence the rate of survival.
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Affiliation(s)
- Adriana J Timmermans
- Department of Head and Neck Oncology and Surgery, University of Amsterdam, Amsterdam, the Netherlands
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10
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Houlton JJ, Hom DB. Approaching Delayed-Healing Wounds on the Face and Neck. Facial Plast Surg Clin North Am 2013; 21:81-93. [DOI: 10.1016/j.fsc.2012.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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11
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Yu P, Hanasono MM, Skoracki RJ, Baumann DP, Lewin JS, Weber RS, Robb GL. Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy. Cancer 2010; 116:1718-24. [PMID: 20120029 DOI: 10.1002/cncr.24947] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND : Pharyngoesophageal defects traditionally have been reconstructed using a jejunal or radial forearm flap. In 2002, the authors began using the anterolateral thigh flap for pharyngoesophageal reconstruction, and it has become our preferred method. The purpose of this study was to analyze the clinical and functional outcomes achieved using this technique. METHODS : The medical records of 91 male and 23 female patients who underwent pharyngoesophageal reconstruction using an anterolateral thigh flap were retrospectively reviewed. Outcomes analyzed included length of hospital and intensive care unit stay, fistula and anastomotic stricture formation and other complications, swallowing and tracheoesophageal speech function, and survival. Most patients had primary (27%) or recurrent (42%) squamous cell carcinoma. Before reconstruction, 71% of patients had undergone surgery, radiotherapy, or both. There were 67 circumferential and 47 near-circumferential defects. RESULTS : Mean intensive care unit stay was 1.9 +/- 2.2 days, and mean hospital stay was 9.0 +/- 4.7 days. Two patients experienced total flap loss, and 1 patient had partial flap necrosis. Pharyngocutaneous fistulas and strictures occurred in 9% and 6% of patients, respectively. Ninety-one percent of patients tolerated an oral diet without the need for tube feeding. Tracheoesophageal puncture was performed for speech rehabilitation in 51 patients. Eight-one percent of patients with a secondary tracheoesophageal puncture achieved fluent speech versus 41% of patients with a primary tracheoesophageal puncture. CONCLUSIONS : This series demonstrates that excellent clinical and functional outcomes, with minimal donor site morbidity and quick recovery, are possible with pharyngoesophageal reconstruction using an anterolateral thigh flap. Cancer 2010. (c) 2010 American Cancer Society.
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Affiliation(s)
- Peirong Yu
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Gonçalves AJ, de Souza JAL, Menezes MB, Kavabata NK, Suehara AB, Lehn CN. Pharyngocutaneous fistulae following total laryngectomy comparison between manual and mechanical sutures. Eur Arch Otorhinolaryngol 2009; 266:1793-8. [PMID: 19283399 DOI: 10.1007/s00405-009-0945-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 02/23/2009] [Indexed: 10/21/2022]
Abstract
The extension of the surgery and closure type of the pharynx can be the determinants in the pharyngocutaneous fistula development. The objective of the study is to evaluate the incidence of pharingocutaneous salivary fistulae after total laryngectomies comparing manual and mechanical sutures. The study is designed as non-randomized, prospective clinical study. Sixty patients with squamous cell carcinoma were submitted to total laryngectomies. In 30 cases, the linear stapler (75 mm) closure (surgical technique described in details) and in other 30 cases manual suture was used. The cases of mechanical suture were prospective and consecutive and the cases of manual suture were a review series of patients who underwent a manual suture of pharynx, in the same period of time. The statistical analysis between the two groups concluded that both were comparable. Fistulae incidence was 6.7% (2/30) in the group with the mechanical suture and 36.7% (11/30) in the group with manual suture closure, presenting a significant difference (p = 0.0047). The total laryngectomy with mechanical closure is an easy and fast learning technique, allowing watertight closure of the pharynx with a low risk of contamination of the surgical field. It is an assured method, even in previously irradiated patients, since we respect the limits of its indication regarding the extension of primary tumor that must be confirmed by previous suspension laryngectomy performed in the operating room.
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Affiliation(s)
- Antonio José Gonçalves
- Head and Neck Division, Department of Surgery, Santa Casa Medical School, São Paulo, SP, Brazil.
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13
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Pathak KA, Viallet NR, Nason RW. Sternocleidomastoid muscle interposition to prevent carotid artery blowout. J Surg Oncol 2008; 98:565-6. [DOI: 10.1002/jso.21157] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy. Eur Arch Otorhinolaryngol 2008; 265:929-36. [DOI: 10.1007/s00405-007-0562-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 12/19/2007] [Indexed: 11/30/2022]
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Magdy EA. Surgical closure of postlaryngectomy pharyngocutaneous fistula: a defect based approach. Eur Arch Otorhinolaryngol 2007; 265:97-104. [PMID: 17687561 DOI: 10.1007/s00405-007-0414-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 07/25/2007] [Indexed: 10/23/2022]
Abstract
Surgical repair of postlaryngectomy pharyngocutaneous fistula (PCF) can be challenging. Although several studies describe separate reconstruction methods, only few address the variability in defect characteristics and hence flap selection. The current clinical study presents a retrospective review of 19 patients who underwent surgical repair of persistent PCFs, over a 4-year period in a tertiary referral institute by a single primary surgeon. All but one patient were men with a mean age of 61 +/- 10 years. Nine patients had previous unsuccessful attempts for surgical closure. Previous neck irradiation was the most common comorbid condition encountered (52.6%), followed by low hemoglobin level (47.4%), hepatic disease (36.8%) and diabetes mellitus (31.6%). According to defect characteristics, six patients received a local cervical skin procedure, ten patients had reconstructions using the pectoralis major musculocutaneous flap and three patients required a radial forearm free flap repair. All PCFs were eventually successfully closed with no major complications. Patients were followed-up for an average of 19.7 months (range, 5-38 months). Acceptable oral swallowing results were achieved in all but one patient. In conclusion, successful results are achievable in difficult persistent PCF cases with a defect based reconstruction approach kept in mind.
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Affiliation(s)
- Emad A Magdy
- Department of Otorhinolaryngology-Head and Neck Surgery, Alexandria University Medical School, Alexandria, Egypt.
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Mäkitie AA, Niemensivu R, Hero M, Keski-Säntti H, Bäck L, Kajanti M, Lehtonen H, Atula T. Pharyngocutaneous fistula following total laryngectomy: a single institution’s 10-year experience. Eur Arch Otorhinolaryngol 2006; 263:1127-30. [PMID: 17021782 DOI: 10.1007/s00405-006-0152-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 08/08/2006] [Indexed: 11/24/2022]
Abstract
The etiology of postoperative pharyngocutaneous fistula (PCF) formation following major head and neck surgery is multifactorial and the incidence varies greatly. We reviewed retrospectively the records of 108 consecutive patients who underwent a total laryngectomy during the period from December 1992 to December 2002 at the Helsinki University Central Hospital, Helsinki, Finland. PCF occurred postoperatively in 19 (18%) patients. Two additional patients (2%) developed a PCF later than 30 days after laryngectomy. Nineteen percent of these patients with fistula formation had received previous radiation therapy and laryngectomy was performed for local recurrence. Eighteen (86%) of the all fistulae closed spontaneously and surgical closure of the fistula was performed in three (14%) cases. We conclude that the PCFs in our patient population occurred both in radiated and nonirradiated patients. Although most fistulae close spontaneously without surgical intervention this complication leads to prolonged hospitalization and increased patient morbidity.
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Affiliation(s)
- Antti A Mäkitie
- Department of Otolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, P.O. Box 220, 00029 HUCH, Helsinki, Finland.
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