Post-operative pharyngocutaneous fistula after laryngectomy

Wakisaka, Naohiro; Murono, Shigeyuki; Kondo, Satoru; Furukawa, Mitsuru; Yoshizaki, Tomokazu

doi:10.1016/j.anl.2007.06.002

Cited by 44 publications

(54 citation statements)

References 21 publications

(28 reference statements)

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“…These include age [22, 23], positive histological margins [23–25], suture material [2, 12, 26], primary voice puncture [27–29], oral feeding [30], type of pharyngeal closure [19, 26, 31, 32]. The antibiotics given and their duration depending on the centre [33] but there is no clear evidence for any specific antibiotic regime [34] although clindamycin has been shown to increase complication rates [35].…”

Section: Discussionmentioning

confidence: 99%

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

Hone

Rahman

Wong³

et al. 2016

Eur Arch Otorhinolaryngol

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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.

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Section: Discussionmentioning

confidence: 99%

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

Hone

Rahman

Wong³

et al. 2016

Eur Arch Otorhinolaryngol

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“…This complication leads to increased morbidity, prolonged hospitalization, and greater hospital care expenditure 9,10 . The same happens to patients with early recurring laryngeal tumors after radiotherapy alone 5,6 . In an attempt to prevent or reduce the incidence of salivary fistulas, some authors have advocated the routine use of non-irradiated tissue to reinforce and close the larynx.…”

Section: Introductionmentioning

confidence: 85%

“…On a meta-analysis, Paydarfar & Birkmeyer 15 showed that preoperative radiotherapy increases the risk of pharyngocutaneous fistulas (RR, 2.28; p < 0.001), confirming the findings of other papers, in which fistula incidence rates ere higher in previously irradiated patients when compared to non-irradiated subjects as described by Ganly et al 12 (32% versus 12%, p = 0.012 respectively). The effect of radiotherapy translates into injuries to tissue microvasculature, resulting in myointimal fibrosis, endarteritis, and worsening of atherosclerosis, leading to a hypovascular, hypocellular, and hypoxic environment, reducing healing capacity, increasing the risk for fistula formation, its severity, and duration 5,15,17 . The use of non-irradiated flaps has been recommended to reduce the incidence rates and the morbidities associated with salivary fistulas in salvage laryngectomy patients, even when thee is enough mucosa for a primary closure procedure 3,7 .…”

Section: Discussionmentioning

confidence: 99%

“…The development of organ preservation protocols and primary chemoradiotherapy (CRT) for a subgroup of patients with advanced laryngeal cancer resulted in organ preservation rates of 64% and global survival similar to the levels seen in patients offered laryngectomy followed by radiotherapy, a treatment then considered the standard for this type of cancer [2][3][4] . Despite the efficacy of chemoradiotherapy, a considerable number of patients still require salvage surgery -usually in the form of total laryngectomy -when the disease persists or recurs 5,6 . However, a number of studies have shown high complication rates associated with salvage laryngectomy due to the effects of radiotherapy combined with chemotherapy upon wound healing 3,7 .…”

Section: Introductionmentioning

confidence: 99%

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Laringectomia de resgate: utilização do retalho miocutâneo de peitoral maior na prevenção de fístula faringocutânea

Sousa¹,

Castro²,

Porcaro-Salles³

et al. 2012

Braz. j. otorhinolaryngol.

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Salvage laryngectomy in patients treated with organ preservation protocols is associated with high rates of postoperative complications. The use of non-irradiated tissue flaps in pharyngeal reconstruction could reduce the incidence of these complications. Objective : This study aims to evaluate the usefulness of the pectoralis major myocutaneous flap in preventing salivary fistulae during the postoperative period of salvage total laryngectomy (TL). Materials and Method : This retrospective study enrolled 31 patients operated between April of 2006 and May of 2011. All patients had advanced cancer at the time of the salvage procedure and had been treated with chemoradiotherapy or radiotherapy alone. Pharyngeal reconstruction was performed using pectoralis major myocutaneous flap in 19 cases (61%); primary wound closure occurred in 12 patients (39%). Results : Salivary fistulae occurred in 16% of the patients who received the flap and in 58% of the patients with primary closure of the pharynx ( p < 0.02). No statistically significant differences were noted between the groups with respect to the mean time for fistula formation, reintroduction of an oral diet, or use of a nasoenteric tube for feeding. Conclusion : The pectoralis major myocutaneous flap was found to reduce the incidence of salivary fistulae in salvage laryngectomy procedures.

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“…Clark et al [29] showed that irradiation increased the incidence of postoperative pharyngo-cutaneous fistula from 24% to 38% while Wakisaka [30] et al noted that although the frequency of pharyngocutaneous fistula after RT or CRT was not high, fistula closure tended to be delayed. In their series, Taki et al [5] experienced severe postoperative complications including pharyngocutaneous fistulas in 25% of patients who underwent laryngopharyngectomy.…”

Section: Discussionmentioning

confidence: 99%

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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Post-operative pharyngocutaneous fistula after laryngectomy

Cited by 44 publications

References 21 publications

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

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

Laringectomia de resgate: utilização do retalho miocutâneo de peitoral maior na prevenção de fístula faringocutânea

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

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