Meta-analysis on the rate of pharyngocutaneous fistula in early oral feeding in laryngectomy patients

Singh, Ravjit; Karantanis, William; Fadhil, Matthew; Dow, Cassie; Fuzi, Jordan; Robinson, Rachelle A.; Jacobson, Ian

doi:10.1016/j.amjoto.2020.102748

Cited by 11 publications

(12 citation statements)

References 19 publications

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“…However, these results must be interpreted with caution because the majority of the studies analyzed did not include patient cohorts which are at a greater risk of developing complications, including those who underwent salvage surgery after radio(chemo)therapy, or following extensive surgery with the requirement for free or pedicled flap reconstruction. Furthermore, it should be noted that another meta‐analyze, also published in 2021, has found discordant results 29 . Indeed, in his meta analyze of 14 studies, including four randomized clinical trials and 10 observational studies, Milinis et al 27 observed that the PCF rate in early compared with late oral feeding group was 15.2% versus 11.7% in the randomized clinical trials (RR 1.35 95%CI [0.68–2.7], p = 0.40) and 14.1% versus 20.5% in cohort studies (RR 1.0, 95%CI [0.76–1.3], p = 0.98).…”

Section: Discussionmentioning

confidence: 96%

“…Furthermore, it should be noted that another meta-analyze, also published in 2021, has found discordant results. 29 Indeed, in his meta analyze of 14 studies, including four randomized clinical trials and 10 observational studies, Milinis et al 27 observed that the PCF rate in early compared with late oral feeding group was 15.2% versus 11.7% in the randomized clinical trials (RR 1.35 95%CI [0.68-2.7], p = 0.40) and 14.1% versus 20.5% in cohort studies (RR 1.0, 95%CI [0.76-1.3], p = 0.98). On the other hand, in his meta-analyses of 12 studies, of which 10 are also included in the metaanalyze of Milinis et al Singh et al 29 observed an overall higher risk of PCF in early versus late feeding groups (RR = 1.51, 95% CI: 1.17, 1.96).…”

Section: Discussionmentioning

confidence: 99%

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Management of oral feeding following total laryngectomy around the world: YO‐IFOS international study

et al. 2022

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Background: To analyze worldwide practices regarding the initiation of oral feeding after total laryngectomy (TL). Methods: Online survey.Results: Among the 332 responses received, 278 from 59 countries were analyzed. Our results showed that 45.6% of respondents started water and 45.1% started liquid diet between postoperative days 7 and 10. Semi-solid feeds were initiated between days 10 and 14 for 44.9% of respondents and a free diet was allowed after day 15 for 60.8% of respondents. This timing was significantly delayed in cases of laryngo-pharyngectomy and after prior radiotherapy (p < 0.001). A greater proportion of respondents in Africa and Oceania allowed early oral feeding before day 6 as compared with the rest of the world (p < 0.001). Conclusion: Despite increasing number of publications, there is still a lack of evidence to support early oral feeding. The majority of respondents preferred to delay its initiation until at least 7 days after surgery.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Management of oral feeding following total laryngectomy around the world: YO‐IFOS international study

et al. 2022

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“…While malnutrition should be aggressively corrected during the whole perioperative period [ 17 ], in the setting of a salvage laryngectomy/pharyngolaryngectomy the prophylactic use of a reinforcing flap has been shown to significantly decrease PCF risk [ 18 ]. In addition, while early oral feeding seems to increase PCF risk according to a recent meta-analysis [ 19 ], early oral hydration may actually reduce this probability (by a possible mechanical detersion of infected fluids and saliva on pharyngeal suture) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature

Locatello

Licci

Maggiore

et al. 2021

JCM

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Background: Pharyngocutaneous fistula (PCF) is a frequent complication after total laryngectomy, with an incidence of up to 65%. Many conservative or invasive approaches are available and the choice among them is usually made on a case-by-case basis. The aim of the present review is to critically summarize the available evidence of the effectiveness of the non-surgical management of PCF. Methods: A systematic review and a meta-analysis of the literature were conducted, according to the PRISMA guidelines. Studies investigating botulinum toxin therapy, scopolamine transdermal patch, hyperbaric oxygen therapy (HBOT), and negative pressure wound therapy (NPWT) were assessed. Complete fistula closure after the initiation of non-surgical treatment was the main outcome. Results: After the application of selection criteria, a total of seven articles and 27 patients were included in the present review. All the eligible studies were descriptive case series, while only one article used a standard group as a comparison. The mean age was 63.3 and 14 patients (51.9%) had previously received RT. The reported comorbidities were diabetes, ischemic heart disease, hypertension, dyslipidemia, COPD, and atrial fibrillation. With a mean healing time of 25.0 days, the overall success rate was 92.6%. Conclusions: Non-surgical treatment of PCF is only based on the experience of small series. Although success rates seem promising, the absence of properly designed comparative studies does not allow us, at present, to identify ideal candidates for these non-invasive management strategies for PCF.

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“…Eleven patients (39%) had postoperative PCF within a mean time of 13 ± 5.5 days. Oral intake restarted within a median of 12 days [10,25] postoperatively and the mean hospital stay was 24.2 ± 13.8 days. Most PCFs were treated with local care, consisting of dressings in 60% of cases.…”

Section: Characteristics Of the Populationmentioning

confidence: 99%

Early detection of pharyngocutaneous fistulae after total laryngectomy by cytokine in drainage: A pilot study (DEFILAC)

Saroul,

Loukine,

Durand

et al. 2023

Head & Neck

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BackgroundThe determination of cytokines in the postoperative drainage (POD) fluid could be a method for early detection of the development of a pharyngocutaneous fistula (PCF).Materials and methodsWe conducted a prospective two‐center study involving 28 patients. PODs were collected on Day 1 (D1) and Day 2 (D2) postoperatively for determination of a cytokine panel and cytobacteriological examination.ResultsEleven (39%) patients presented with PCF on average 13 ± 5.5 days after surgery. Patients with PCF had higher IL‐10 (121 vs. 40.3, p = 0.04, effect size (ES) = 0.98 [0.16, 1.79]) and TNFα level (21.2 vs. 2.2, p = 0.02, ES = 0.83 [0.03, 1.63]) on D2. An IL‐10 threshold of 72 pg/mL on D2 was diagnostic of the occurrence of PCF with a sensibility of 70%, specificity of 88%.ConclusionThe determination of cytokines in POD fluid on D2 is a reliable tool for predicting the development of a PCF after total laryngectomy.

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Meta-analysis on the rate of pharyngocutaneous fistula in early oral feeding in laryngectomy patients

Cited by 11 publications

References 19 publications

Management of oral feeding following total laryngectomy around the world: YO‐IFOS international study

Management of oral feeding following total laryngectomy around the world: YO‐IFOS international study

Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature

Early detection of pharyngocutaneous fistulae after total laryngectomy by cytokine in drainage: A pilot study (DEFILAC)

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