Fistulae following laryngectomy in patients treated with irradiation

Natvig, Ketil; Boysen, Morten; Tausjø, Johan

doi:10.1017/s0022215100125484

Cited by 60 publications

(50 citation statements)

References 14 publications

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“…9,11 Some of the irradiated patients in this study received planned preoperative irradiation (n ‫ס‬ 11), but most patients were treated with radiotherapy as primary treatment, and laryngectomy was performed as a salvage therapy (n ‫ס‬ 24). The patients, who had a short interval from the end of radiotherapy to operation had more fistulas than those who had a longer interval.…”

Section: Discussionmentioning

confidence: 99%

The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae

et al. 2000

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Section: Discussionmentioning

confidence: 99%

The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae

et al. 2000

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“…In such cases, primary closure of the pharynx may not be possible or may carry a high risk for pharyngocutaneous fistulas, [4][5][6][7][8] and primary reconstruction of these pharyngoesophageal defects is often required. The goals of reconstruction are to provide alimentary tract continuity and to restore speech and swallowing functions.…”

mentioning

confidence: 99%

Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy

Hanasono

Skoracki

et al. 2010

Cancer

148

137

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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 AE 2.2 days, and mean hospital stay was 9.0 AE 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.

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“…Although the overall incidence of postlaryngectomy pharyngocutaneous fistulas has decreased significantly in the past decade, it remains very high in previously irradiated patients. 48,49,50,51,52 McCombe et al 49 reported that the incidence increased from 4% to 39% when radiation was included in multimodal therapy. Recent studies have shown that the mean overall survival of patients after salvage total laryngectomy was 7.2 years.…”

Section: Reconstruction Of Postlaryngectomy Pharyngocutaneous Fistulasmentioning

confidence: 99%