Salvage total laryngectomy: is a flap necessary?

Álvarez-Morujo, Ricardo González-Orús; Pascual, Paula Martínez; Tucciarone, Manuel; Fernández, Mario Fernández; Encabo, Rosalía Souvirón; Guirado, Tomás Martinez

doi:10.1016/j.bjorl.2018.11.007

Cited by 17 publications

(16 citation statements)

References 28 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Busoni et al reported that fistula management was always conservative after primary TL, while surgical closure with regional flaps prevailed in patients who had undergone salvage TL after CRT 14 . Other authors even recommended using a prophylactic PM flap repair during salvage TL to reduce the incidence, severity, and persistence of PCF 15 . The present results confirmed a higher rate of PCF development in patients undergoing salvage TL after previous unsuccessful RT, as reported in the available literature 13,14,16 .…”

Section: Discussionsupporting

confidence: 87%

“…14 Other authors even recommended using a prophylactic PM flap repair during salvage TL to reduce the incidence, severity, and persistence of PCF. 15 The present results confirmed a higher rate of PCF development in patients undergoing salvage TL after previous unsuccessful RT, as reported in the available literature. 13,14,16 Such patients are also at higher risk of PCF when ND is performed.…”

Section: Functional Outcomessupporting

confidence: 92%

See 1 more Smart Citation

Oncological and Functional Outcomes of Primary and Salvage Total Laryngectomy

et al. 2020

View full text Add to dashboard Cite

Objectives To evaluate and compare the oncological and functional outcomes of total laryngectomies (TL) performed as first line treatment or for salvage after failure of conservative approaches for treating advanced laryngeal carcinoma (LSCC). Study Design A retrospective cohort study. Methods A cohort of 217 patients who underwent TL was divided according to whether the procedure was for primary treatment of their LSCC (101 patients) or for recurrences after conservative surgery or chemo‐radiotherapy (116 patients). Results The overall survival rate and disease‐specific survival rate were significantly higher in the primary TL group than in the salvage TL group (P = .04 and P = .01, respectively). The recurrence rate was significantly higher and the disease‐free survival (in months) was shorter for patients who had salvage TL than for those who had primary TL (P = .00 and P = .01, respectively). The salvage TL group also included significantly more cases of postoperative pharyngo‐cutaneous fistula needing salivary stent positioning, and experienced significantly longer hospital stays than the primary TL group (P = .04 and P = .03, respectively). Conclusion Oncological and functional outcomes of primary TL were significantly better than after salvage TL. If salvage TL was performed after conservative surgery had failed, the oncological and functional results were better than after the failure of organ‐preserving protocols. This could justify a first attempt at conservative surgery for intermediate‐advanced LSCC in selected cases, reserving chemo‐radiotherapy only for patients unsuitable for surgery. Level of Evidence 4 Laryngoscope, 131:E569–E575, 2021

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Functional Outcomessupporting

confidence: 92%

Oncological and Functional Outcomes of Primary and Salvage Total Laryngectomy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…After scrupulous full-text review, 24 articles published from 2005 to 2020 met full selection criteria for qualitative data pooling. 12,15,25-46 The 90 omitted articles, with reasons for exclusion, are listed in Appendix 2 (available online).…”

Section: Resultsmentioning

confidence: 99%

“…Forest plots of the data are shown in Figure 3. Within the 24 final articles included, 18 described pectoralis onlay 44 2014 Ireland Retrospective case series Chao 39 2015 USA Retrospective case series Chiesa Estomba 33 2018 Spain Retrospective case series Cö mert 45 2014 Turkey Retrospective case series Gendreau-Lefèvre 28 2015 Canada Retrospective case series Gil 40 2009 USA Retrospective case series Gilbert 46 2014 USA Retrospective case series Gonzalez-Orus 36 2020 Spain Retrospective case series Halkud 25 2014 38 2020 Japan Retrospective case series Oosthuizen 43 2012 Ireland Retrospective case series Patel 15 2013 USA Retrospective case series Righini 35 2005 France Retrospective case series Sabra 30 2016 Egypt Retrospective case series Sayles 27 2014 UK Retrospective case series Sharma 31 2016 India Retrospective case series Sittitrai 34 2018 Thailand Retrospective case series Sundaram 42 2009 USA Retrospective case series Abbreviation: MINORS, Methodological Index for Non-randomized Studies. versus primary closure.…”

Section: Meta-analysesmentioning

confidence: 99%

“…Twelve articles describing the incidence of major PCF were included for metaanalysis. [27][28][29][30][31][33][34][35][36]38,40,43 Major PCF occurred in 3.9% (11/ 280) and 19.4% (103/532) of pectoralis onlay and primary closure alone, respectively. The calculated OR of onlay closure was 0.21 (95% CI, 0.11-0.38; P \ .001) for development of major PCF.…”

Section: Meta-analysesmentioning

confidence: 99%

See 1 more Smart Citation

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta‐analysis

Cabrera

Jones

Parker

et al. 2020

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.

show abstract

Latissimus dorsi myocutaneous free flap for the laryngopharyngectomy defect

Kinkhabwala,

Amin,

Rist

et al. 2024

Head & Neck

View full text Add to dashboard Cite

BackgroundPartial or total laryngopharyngectomy defects have traditionally been reconstructed using the radial forearm, anterolateral thigh, or jejunal free flaps. The latissimus dorsi myocutaneous free flap (LDMFF) is an option for high‐risk patients with complex laryngopharyngeal ± cutaneous neck defects.MethodsRetrospective single‐surgeon case series from 2017 to 2022. Outcomes were assessed at both the back donor site and head and neck.ResultsTwenty‐four patients were identified. Flap survival was 100%. There was 1 (4.2%) pharyngocutaneous fistula and 2 (8.3%) tracheo‐esophageal peristomal fistulas. At last follow‐up, 17 (71%) were sustaining weight on oral intake, and 7 (29%) were G‐tube dependent with 4 of these able to do some type of oral intake. Seven (29.2%) had post‐operative stricture/stenosis requiring dilation. There were only minor donor site complications, all managed conservatively.ConclusionsThe LDMFF can be a robust reconstructive option, particularly for radiated high‐risk patients with complex pharyngeal defects, including skin.

show abstract

Salvage total laryngectomy: is a flap necessary?

Cited by 17 publications

References 28 publications

Oncological and Functional Outcomes of Primary and Salvage Total Laryngectomy

Oncological and Functional Outcomes of Primary and Salvage Total Laryngectomy

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta‐analysis

Latissimus dorsi myocutaneous free flap for the laryngopharyngectomy defect

Contact Info

Product

Resources

About