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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 2024:10.1007/s00405-024-08696-9. [PMID: 38739184 DOI: 10.1007/s00405-024-08696-9] [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: 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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2
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Ding S, Zhang Y, Guo W, Yin G, Huang Z, Zhong Q. Impact of stapler versus manual closure techniques on pharyngocutaneous fistula development post-total laryngectomy: A systematic review and meta-analysis. Int Wound J 2024; 21:e14751. [PMID: 38472132 PMCID: PMC10932772 DOI: 10.1111/iwj.14751] [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: 01/01/2024] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 03/14/2024] Open
Abstract
Pharyngocutaneous fistula (PCF) is a major complication after total laryngectomy, with significant morbidity and mortality. Whether mechanical stapler closure of the pharynx reduces fistula rates compared to hand-sewn techniques remains unclear. We conducted an updated systematic review and meta-analysis to clarify this question. Five databases were systematically searched from inception through November 2023 for studies comparing stapler versus suture closure for fistula outcomes after laryngectomy. Odds ratios (OR) were pooled using random-effects models and fixed-effects models. Subgroup and sensitivity analyses were performed. Risk of bias was appraised using NHLBI tools. Nine studies with 803 patients were included. Mechanical closure significantly reduced fistula incidence versus suture closure (OR = 0.57, 95% CI 0.34-0.95, p = 0.03). Subgroup analysis found that stapling's protective effect varied by patient age, country/region, linear stapler size and female percentage. Stapling reduced fistula odds by 80% in the Turkey subgroup (OR = 0.20, 95% CI 0.09-0.50) but showed no benefit in other regions. Patients <60 years showed an 84% fistula reduction with stapling (OR = 0.17, 95% CI 0.06-0.45), whereas older subgroups did not. Linear stapler size of 60 mm significantly reduced fistula occurrence while 75 mm did not. There was no evidence that low female percentage mitigated stapling benefits. Mechanical stapler closure after total laryngectomy meaningfully reduces the likelihood of postoperative PCF formation compared to hand-sewn closure, especially for patients younger than 60 years old. The absolute risk reduction supports its utility to prevent this complication.
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Affiliation(s)
- Shuo Ding
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Yang Zhang
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Wei Guo
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Gaofei Yin
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Zhigang Huang
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Qi Zhong
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
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3
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Sanabria A, Olivera MP, Chiesa-Estomba C, Hamoir M, Kowalski LP, López F, Mäkitie A, Robbins KT, Rodrigo JP, Piazza C, Shaha A, Sjögren E, Suarez C, Zafereo M, Ferlito A. Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review. Adv Ther 2023; 40:3681-3696. [PMID: 37436593 PMCID: PMC10427525 DOI: 10.1007/s12325-023-02561-7] [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: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION The most common early postoperative complication after total laryngectomy (TL) is pharyngocutaneous fistula (PCF). Rates of PCF are higher in patients who undergo salvage TL compared with primary TL. Published meta-analyses include heterogeneous studies making the conclusions difficult to interpret. The objectives of this scoping review were to explore the reconstructive techniques potentially available for primary TL and to clarify which could be the best technique for each clinical scenario. METHODS A list of available reconstructive techniques for primary TL was built and the potential comparisons between techniques were identified. A PubMed literature search was performed from inception to August 2022. Only case-control, comparative cohort, or randomized controlled trial (RCT) studies were included. RESULTS A meta-analysis of seven original studies showed a PCF risk difference (RD) of 14% (95% CI 8-20%) favoring stapler closure over manual suture. In a meta-analysis of 12 studies, we could not find statistically significant differences in PCF risk between primary vertical suture and T-shaped suture. Evidence for other pharyngeal closure alternatives is scarce. CONCLUSION We could not identify differences in the rate of PCF between continuous and T-shape suture configuration. Stapler closure seems to be followed by a lower rate of PCF than manual suture in those patients that are good candidates for this technique.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Alma Mater, Cra. 51d #62-29, Medellín, Colombia.
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
| | - María Paula Olivera
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Alma Mater, Cra. 51d #62-29, Medellín, Colombia
| | - Carlos Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Donostia-San Sebastian, Guipuzkoa-Basque Country, Spain
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, and Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, and the Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan Pablo Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Elizabeth Sjögren
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Mark Zafereo
- Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35125, Padua, Italy
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Penêda JF, Fernandes J, Monteiro E. Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:485-491. [PMID: 37274999 PMCID: PMC10235409 DOI: 10.1007/s12070-022-03311-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: 02/04/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding which patients are at higher risk for fistula development. This article comprised a literature review about risk factors for fistula development. All articles published on an on-line database (PUBMED™) using MESH terms "larynx cancer" and "fistula" in a 5-year period (January 1st, 2014 to January 27th, 2019) were included. Further articles were selected due to expert suggestion by one of the senior surgeons. Only articles written in Portuguese or English were included. Animal studies were excluded. 151 articles were selected and abstracts analysed. 82 articles were selected for full text revision. 32 were later excluded because they described single clinical cases, experimental surgical technics, irrelevant data or poor methodology. Final selection comprised 50 studies: 9 systematic reviews, one non-systematic review, 34 unicentric and 4 multicentric retrospective analysis and two prospective studies. There is no consensus regarding risk factors for fistula development. Patients submitted to salvage surgery for advanced disease seem to be at greater risk. Bad nutritional status is a logical contributor, but the ideal surrogate marker is still missing. Several variables are inconsistently pointed as risk factors and should be abandoned unless proved otherwise. There are no standard scores for fistula occurrence despite being a common complication following surgery.
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Affiliation(s)
- José Ferreira Penêda
- Otorhinolaryngology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal
| | - João Fernandes
- Otorhinolaryngology Department, Instituto Português de Oncologia do Porto–Francisco Gentil (IPOP FG), Porto, Portugal
| | - Eurico Monteiro
- Otorhinolaryngology Department, Instituto Português de Oncologia do Porto–Francisco Gentil (IPOP FG), Porto, Portugal
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5
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Chiesa-Estomba CM, Mayo-Yanez M, Palacios-García JM, Lechien JR, Viljoen G, Karkos PD, Barillari MR, González-García JA, Sistiaga-Suarez JA, González-Botas JH, Ayad T, Ferlito A. Stapler-Assisted Pharyngeal Closure After Total Laryngectomy: A Systematic Review and Meta-Analysis. Oncol Ther 2022; 10:241-252. [PMID: 35357676 PMCID: PMC9098751 DOI: 10.1007/s40487-022-00193-5] [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] [Received: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Pharyngocutaneous fistula (PCF) remains the most frequent complication following total laryngectomy (TL). Pharyngeal closure with a surgical stapler (SAPC) has been proposed as an effective closure technique that decreases the rate of PCF, reduces surgical time, decreases the length of hospital stay, and shortens the time required before safely initiating oral feeding. Methods This study involved a systematic review and meta-analysis of patients with laryngeal cancer who underwent TL and with subsequent stapler pharyngeal closure, in order to analyse the current literature regarding the role of SAPC after TL. Results The incidence of PCF in the stapler-assisted suture group (SASG) was 9.5% (95% CI 8.2–15.9%), with a mean absolute deviation of 1.12, while in the hand-suture group (HSG) group the incidence was 23.4% (95% CI 23–26.1%), with a mean absolute deviation of 5.71 (p = 0.01). Conclusions SAPC may decrease the risk of PCF in patients following TL. Based on the current data, SAPC appears to shorten the surgical time and the length of hospital stay. Nevertheless, prospective randomized trials are required to validate these findings.
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Affiliation(s)
- Carlos M Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Calle Doctor Begiristain, #1. CP. 20014, Donostia-San Sebastian, Gipuzkoa-Basque Country, Spain. .,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.
| | - Miguel Mayo-Yanez
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006, A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Santiago de Compostela, Spain.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Jose M Palacios-García
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Virgen Macarena, Seville, Spain.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Gerrit Viljoen
- Division of Otolaryngology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Petros D Karkos
- Department of Otolaryngology-Head and Neck Surgery, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria R Barillari
- Department of Mental and Physical Health and Preventive Medicine, "L. Vanvitelli" University, Naples, Italy.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, Canada
| | - Jose A González-García
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Calle Doctor Begiristain, #1. CP. 20014, Donostia-San Sebastian, Gipuzkoa-Basque Country, Spain
| | - Jon A Sistiaga-Suarez
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Calle Doctor Begiristain, #1. CP. 20014, Donostia-San Sebastian, Gipuzkoa-Basque Country, Spain
| | - Jesus Herranz González-Botas
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006, A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Santiago de Compostela, Spain
| | - Tareck Ayad
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, Canada.,Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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6
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Lee YC, Fang TJ, Kuo IC, Tsai YT, Hsin LJ. Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: A systematic review and meta-analysis. Clin Otolaryngol 2021; 46:692-698. [PMID: 33345446 DOI: 10.1111/coa.13702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/27/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Total laryngectomy (TL) is a life-saving procedure for individuals with advanced laryngeal cancer and those suffering from recurrence after initial treatment. The present study aimed to evaluate the differences between stapler closure (SC) and manual closure (MC) of the pharynx during TL for patients with laryngeal cancer. DESIGN/SETTING A systematic literature search was performed using the PubMed, EMBASE and Cochrane Library databases. The data were analysed using Comprehensive Meta-Analysis software (Version 3; Biostat). Dichotomous data were calculated as odds ratios (ORs), and continuous data were calculated as mean differences (MD) with 95% confidence intervals (CI). MAIN OUTCOME/RESULTS A total of seven studies (535 patients) were included in this meta-analysis. Pooled analysis showed that the operative time of TL was significantly reduced in the SC group (MD, -63.2; 95% CI, -106.0 to -20.4). Moreover, the SC group had a lower incidence of pharyngocutaneous fistula (OR = 0.38; 95% CI, 0.18 to 0.83; P = .016) and hospital stay (MD, -2.9; 95% CI, -5.6 to -0.1). The incidence of postoperative surgical site infection (OR = 0.41; 95% CI, 0.02 to 8.73; P = .565) was comparable between the two groups. CONCLUSION Based on these results, SC may be a useful option for patients who need TL.
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Affiliation(s)
- Yi-Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Chun Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yao-Te Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Jen Hsin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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7
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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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8
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Pharyngeal closure after a total laryngectomy: mechanical versus manual technique. The Journal of Laryngology & Otology 2020; 134:626-631. [PMID: 32723416 DOI: 10.1017/s0022215120001371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique. METHODS A retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent). RESULTS Mechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009). CONCLUSION Mechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.
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9
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Galli J, Salvati A, Di Cintio G, Mastrapasqua RF, Parrilla C, Paludetti G, Almadori G. Stapler Use in Salvage Total Laryngectomy: A Useful Tool? Laryngoscope 2020; 131:E473-E478. [PMID: 32415791 DOI: 10.1002/lary.28737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze stapler benefits in salvage total laryngectomy in terms of surgical time, hospitalization length, oral feeding time, and occurrence of pharyngocutaneous fistula, and to evaluate risk factors for its onset. STUDY DESIGN Retrospective analysis. METHODS One hundred fourteen patients affected by endolaryngeal squamous cell carcinoma who underwent salvage total laryngectomy following primary treatment failure were reviewed. We divided patients into two groups based on type of pharyngeal suture performed: mechanical suture with stapler (group A) and manual suture (group B). These two groups were compared for surgical time, start of oral feeding, hospitalization length, surgical margins and pharyngocutaneous fistula incidence considering its relationship with diabetes mellitus, nutritional status, primary treatment, and neck dissection. RESULTS In group A and group B, oral feeding restarting time was 15 ± 9.33 versus 20.03 ± 13.81 days, hospitalization was 17.63 ± 10.08 versus 23.72 ± 14.29 days, and surgery lasted 268.39 ± 76.93 versus 294.26 ± 140.58 minutes, respectively (P < .05). Surgical margins resulted infiltrated in two patients (4.3%) in group A and 12 patients in group B (17.6%) (P = .03). Twenty-one patients (18.4%) presented with pharyngocutanoeus fistula. In group A and group B the incidence of fistula was 15.2% and 20.6%, respectively (P = .468). Fistula occurred in 7 of 18 diabetic patients (38.9%) and 14 of 96 (14.6%) nondiabetic patients (P = .015). Nineteen fistulas (90.5%) occurred in patients who had undergone previous radiation treatment (P = .013). CONCLUSIONS Using a stapler shortened operative time and hospitalization, while also providing a faster restart of oral feeding. Moreover, mechanical pharyngeal suture seems to decrease fistula rate even though its prevention role in salvage laryngectomy should be confirmed by further studies. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E473-E478, 2021.
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Affiliation(s)
- Jacopo Galli
- Department of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation Scientific Institute for Research, Hospitalization and Healthcare, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Salvati
- Department of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation Scientific Institute for Research, Hospitalization and Healthcare, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Di Cintio
- Department of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation Scientific Institute for Research, Hospitalization and Healthcare, Catholic University of the Sacred Heart, Rome, Italy
| | - Rodolfo F Mastrapasqua
- Department of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation Scientific Institute for Research, Hospitalization and Healthcare, Catholic University of the Sacred Heart, Rome, Italy
| | - Claudio Parrilla
- Department of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation Scientific Institute for Research, Hospitalization and Healthcare, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Department of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation Scientific Institute for Research, Hospitalization and Healthcare, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Almadori
- Department of Otorhinolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation Scientific Institute for Research, Hospitalization and Healthcare, Catholic University of the Sacred Heart, Rome, Italy
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10
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Öztürk K, Turhal G, Öztürk A, Kaya İ, Akyıldız S, Uluöz Ü. The Comparative Analysis of Suture versus Linear Stapler Pharyngeal Closure in Total Laryngectomy: A Prospective Randomized Study. Turk Arch Otorhinolaryngol 2019; 57:166-170. [PMID: 32128512 DOI: 10.5152/tao.2019.4469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/07/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to prospectively evaluate and compare the outcomes in patients undergoing pharyngeal closure with the linear stapler and suture techniques after total laryngectomy. Methods Forty-one patients who needed total laryngectomy for laryngeal cancer were enrolled in the study. Patients were randomized into two groups according to the pharyngeal closure technique: the linear stapler group (Group A) and the suture closure group (Group B). Rate of pharyngocutaneous fistula (PCF), nasogastric tube (NGT) removal time and pharyngeal closure time were analyzed and compared between the two groups. Results PCF developed in three patients in Group A (14.3%) and in seven patients in Group B (35%). Although the rate of PCF was lower in Group A, this did not represent a statistical difference (p:0.129). Median NGT removal time was 12 days (IQR=3) and 19.5 days (IQR=1) in Groups A and B, respectively. Median NGT removal time was not statistically different between the two groups (p:0.642). All patients were able to swallow liquids and solids without difficulty. Median pharyngeal closure time was 3 minutes (IQR=1) and 37.5 minutes (IQR=9) in Groups A and B, respectively. Median pharyngeal closure time was significantly lower in Group A (p:0.00). Conclusion The linear stapler technique in total laryngectomy is a reliable, safe, easy-to-apply and time-saving method. Closure with linear stapler significantly reduces pharyngeal closure time without adverse effect on NGT removal times and PCF rates.
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Affiliation(s)
- Kerem Öztürk
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Göksel Turhal
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Arın Öztürk
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - İsa Kaya
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Serdar Akyıldız
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Ümit Uluöz
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
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Allegra E, Mantia IL, Azzolina A, Natale MD, Trapasso S, Saita V. Total Laryngectomy with Horizontal Mechanical Closure of the Pharyngoesophagectomy: Evaluation of the Effectiveness in Elderly Patients. Int Arch Otorhinolaryngol 2019; 23:e338-e342. [PMID: 31360256 PMCID: PMC6660295 DOI: 10.1055/s-0039-1685155] [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] [Received: 03/02/2018] [Accepted: 02/13/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction
The main modalities of surgical treatment for laryngeal cancer include transoral laser microsurgery (TLM), open preservation surgery, and total laryngectomy (TL). In the elderly, for the presence of comorbidities, the surgical approach more appropriate in many cases remains TL. The use of a stapler for the closure of the esophagus has been introduced to reduce surgical time and postoperative complications such as pharyngocutaneous fistula (PCF).
Objective
In the present study, we have evaluated the effectiveness of the use of the horizontal mechanical pharyngoesophageal closure in patients who underwent TL.
Methods
This nonrandomized study was performed on consecutive patients with histopathologically proven squamous cell endolaryngeal carcinoma. The TL was performed using a linear stapler to mechanically suture the pharyngotomy using the semiclosed technique.
Results
A total of 33 patients underwent TL, and 13 of them underwent neck dissection. A total of 15 patients (45.4%) were ≤70 years old, and 18 were > 70 years old. Analyzing the results in relation to age, patients > 70 years old showed tumors at an earlier stage than those aged ≤70 years old. Furthermore, in this group there was a greater number of patients who had comorbidities (
p
= 0.014). In total, we had 2 (6%) cases of PCF in 6.6% in the group ≤70 years old, and in 5.5% of the group > 70 years old (
p
= 1.00).
Conclusions
The use of the stapler for the horizontal closure of the pharyngoesophagectomy in the patients subjected to TL is proven to be useful and safe even when used in elderly patients.
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Affiliation(s)
- Eugenia Allegra
- Otolaryngology Unit, Department of Health Science, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Ignazio La Mantia
- Otolaryngology Unit, Santa Marta e Santa Venera Hospital, Acireale, Catania, Italy
| | - Alfio Azzolina
- Otolaryngology Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | | | - Serena Trapasso
- Otolaryngology Unit, Department of Health Science, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Vincenzo Saita
- Otolaryngology Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
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12
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Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal. Eur Arch Otorhinolaryngol 2018; 276:143-151. [DOI: 10.1007/s00405-018-5200-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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