Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis

Abstract

Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy.

Free Flap Versus Pedicled Flap Reconstruction of Laryngopharyngeal Defects: A 10‐Year National Surgical Quality Improvement Program Analysis

“…There are several known risk factors for postoperative complications after a TL or TLP. 9,24 In addition to patient comorbidities, 17,23-25 several other factors have been associated with complications after TL, including closure technique, 26,27 surgeon experience, 28 use of salivary bypass tubes, [29][30][31] administration of perioperative antibiotics, 32,33 and perioperative use of proton pump inhibitors. 34 Significant predictors of complications after reconstruction in this study, for TL or TLP with reconstruction were a history of stroke and low preoperative hematocrit, whereas older age and recent history of congestive heart failure were predictors of increased hospital stay.…”

Reconstruction of Pharyngeal Defects

“…While some maintain that salivary bypass tubes help funnel saliva into the oesophagus while bypassing the anastomosis, other denounce them as propagators of fistulation. Hone et al found that in patients where a salivary bypass tube was used, the fistula rate was 8.3% compared to 24.6% in the control group [56]. However, in their multivariate analysis, this difference was not borne out to be significant.…”

Pharyngocutaneous Fistulas Following Total Laryngectomy

“…This may factor in the decision to use a salivary bypass tube after total laryngectomy (a Montgomery tube). Some authors reported favorable results using this method [10] -but the small sample size of the study groups, as well as a lack of uniform inclusion criteria and patient distribution resulted in results that were not statistically significant [11,12].…”