Incidence, Predisposing Factors and Outcome of Pharyngocutaneous Fistulas Complicating Head and Neck Cancer Surgery

Dedo, Douglas D.; Alonso, William; Ogura, Joseph H.

doi:10.1177/000348947508400616

Cited by 76 publications

(52 citation statements)

References 10 publications

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“…As a comparison, pharyngocutaneous fistulas after laryngectomy without previous therapy occurred in about 11% for hypopharyngeal [32] and in 4% for laryngeal carcinomas [33].…”

Section: Discussionmentioning

confidence: 97%

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

Dequanter¹,

Vercruysse²,

Shahla³

et al. 2011

OJST

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Introduction: for organ and function preservation, chemoradiotherapy is gaining popularity for primary treatment of advanced head and neck cancer, reserveing surgery for salvage. Methods: Retrospective outcome analysis to determine the results of salvage surgery after failure of primary treatment of advanced head and neck cancer by chemoradiotherapy. 104 patients with advanced head and cancer were initially treated by chemoradiotherapy. Follow-up was evaluated in 27 patients undergoing salvage surgery for recurrent tumor (larynx n = 13; oral cavity n = 9; hypopharynx n = 5). The initial tumor is stage T3 in 11 cases and T4 in 16 cases. 10 patients had primary tumors stage III and 17 patients had tumors stage IV. Results: One postoperative death occured following surgery. The overall incidence of complications was 9/ 27 (%). Recurrent disease developed at the primary initially treated in 25 cases and in the neck in 2 cases after a mean follow-up of 11 months (3 -136 months). After salvage surgery, loco-regional recurrence and/ or distant disease developed in 10/27 patients after a mean follow-up of 4 months. 6/10 (60%) patients died after re-recurrence despite salvage chemotherapy. Conclusion: Salvage surgery after failure of initial chemoradiotherapy is burdened with high morbidity and bad oncological outcome. We demonstrated that it is difficult to salvage locally recurrent head and neck cancer especially at more advanced T-stages or when tumor recur. The limited effect of surgical salvage for recurrent tumor need to be addressed when choosing the initial treatment plan.

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“…As a comparison, pharyngocutaneous fistulas after laryngectomy without previous therapy occurred in about 11% for hypopharyngeal [32] and in 4% for laryngeal carcinomas [33].…”

Section: Discussionmentioning

confidence: 97%

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

Dequanter¹,

Vercruysse²,

Shahla³

et al. 2011

OJST

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“…The reported incidence of pharyngocutaneous fistula ranges from 5 to 65 % [4][5][6][7][8]. Its occurrence vastly increases the length of stay and consequently, the costs of treatment [5].…”

Section: Discussionmentioning

confidence: 99%

“…It leads to increased morbidity, delay in adjuvant treatment, prolonged hospitalization, and increased treatment costs [3]. The reported incidence of pharyngocutaneous fistula is extremely variable in the literature ranging from 5 to 65 % [4][5][6][7][8] but rate between 12 and 30 % has been often reported.…”

Section: Introductionmentioning

confidence: 99%

Pharyngocutaneous Fistula Incidence After PMMC Patch Pharnygoplasty for Post Laryngectomy Defect Reconstruction – Predictive Factors, Our Experience at KMIO

Lakhera

Shenoy

Chavan

et al. 2015

Indian J Surg Oncol

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To analyse pharyngocutaneous fistula, post Pectoralis major myocutaneous patch pharnygoplasty, and its association with various tumor, patient and treatment related factors. It is a retrospective study that included 48 patients who underwent laryngectomy and PMMC patch pharyngeal reconstruction from year 2009 to 2013. We studied the previously reported factors that could influence fistula formation such as age, gender, previous radiotherapy, previous tracheostomy, location of tumor, extent of tumor, tumor volume, tumor stage and surgical margins. Pharyngocutaneous fistula was observed in 13(27.1 %) cases. In 84.6 % (n=11) patients, fistula closure was achieved by conservative measures. No statistically significant association was found between tumor location, extent and size. There was no association between history of previous tracheostomy and postoperative microscopic margin status. Patients with T4 disease showed increased association (36.7 %) compare to T3 stage (11 %) (p value-0.0362). Postoperatively 6 patients presented with dysphagia out of which 4 patients (66.7 %) had history of leak. It also showed significant increase in post operative stay and delay in oral feeding in fistula patients. There is still no consensus regarding the most significant risk factors, our data showed that, most disease and treatment related parameters were not predictive for fistula occurence. Prabably a larger number of patient cohart need to be analysed for additional information.

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“…Five of 8 fistulae occurred in 11 patients who had undergone prior radiation therapy. Since Stell et al [24] and Dedo et al [25] have shown that the risk of fistula after laryngectomy is considerably higher in irradiated patients, we would caution against the use of the stapler in patients who have received radiation. Also the use of stapling devices is probably not indicated after laryngopharyngeetomy performed for treatment of piriform sinus cancer.…”

Section: Discussionmentioning

confidence: 99%

Staple closure of the hypopharynx after diverticulectomy and total laryngectomy

Wolfensberger

Simmen

1991

Dysphagia

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The use of stapling devices to close hypopharyngeal defects was first published in 1969 but the technique does not seem to have gained much popularity among head and neck surgeons. Fifty-nine hypopharyngeal defects were closed using a linear stapler between January, 1984, and April, 1989, at the Department of Otolaryngology, Head and Neck Surgery of the University Hospital of Zurich. Twenty closures were performed following resection of hypopharyngeal diverticula, 39 following wide field laryngectomy. A total of 10 salivary fistulae was observed: 2 after diverticulectomy (10%), 3 after laryngectomy in nonirradiated patients (11%), and 5 after laryngectomy in irradiated patients (45%). These fistula rates are comparable with average rates quoted in the literature. Only after laryngectomy for radiation failure was the fistula rate unusually high. No other complications were seen that could have been attributed to this type of pharyngeal closure. Closure of a hypopharyngeal defect with a stapler is easier and faster than with traditional suture methods. Provided the patient has not been previously irradiated, staple closure of the hypopharynx appears to be as reliable as closure by standard techniques and can be safely recommended.

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Incidence, Predisposing Factors and Outcome of Pharyngocutaneous Fistulas Complicating Head and Neck Cancer Surgery

Cited by 76 publications

References 10 publications

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

Pharyngocutaneous Fistula Incidence After PMMC Patch Pharnygoplasty for Post Laryngectomy Defect Reconstruction – Predictive Factors, Our Experience at KMIO

Staple closure of the hypopharynx after diverticulectomy and total laryngectomy

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