Prediction of pharyngocutaneous fistula and survival after salvage laryngectomy for laryngohypopharyngeal carcinoma

Kim, Yong Han; Roh, Jong–Lyel; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

doi:10.1002/hed.25786

Cited by 10 publications

(13 citation statements)

References 35 publications

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“…26 The rate of post-salvage total laryngectomy fistula in our study was 29 per cent, which is in agreement with the literature. Chemoradiotherapy at primary treatment, 12 bilateral neck dissection, 5 prior tracheostomy 27 and pre-operative haemoglobin levels 17 predispose the patient to fistula formation. Two meta-analyses and one recent study, led by the Microvascular Committee of the American Academy of Otolaryngology Head and Neck Surgery, support the prophylactic use of vascularised tissue (free flaps and regional flaps) in reducing the rate of fistula.…”

Section: Discussionmentioning

confidence: 99%

Twenty-year experience with salvage total laryngectomy: lessons learned

et al. 2021

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Objective The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement. Method A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed. Results Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1–T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent. Conclusion More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

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Section: Discussionmentioning

confidence: 99%

Twenty-year experience with salvage total laryngectomy: lessons learned

et al. 2021

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“…Radiotherapy [24][25][26][27] and tracheostomy 24,28 before TL have both been identified as independent factors that are associated with a higher rate of PCF. However, the pooled prevalence of patients receiving preoperative tracheostomy and radiotherapy was significantly higher in the SC group.…”

Section: Discussionmentioning

confidence: 99%

Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: A systematic review and meta‐analysis

Lee

Fang

Kuo

et al. 2021

Clinical Otolaryngology

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Objective Total laryngectomy (TL) is a life‐saving procedure for individuals with advanced laryngeal cancer and those suffering from recurrence after initial treatment. The present study aimed to evaluate the differences between stapler closure (SC) and manual closure (MC) of the pharynx during TL for patients with laryngeal cancer. Design/Setting A systematic literature search was performed using the PubMed, EMBASE and Cochrane Library databases. The data were analysed using Comprehensive Meta‐Analysis software (Version 3; Biostat). Dichotomous data were calculated as odds ratios (ORs), and continuous data were calculated as mean differences (MD) with 95% confidence intervals (CI). Main Outcome/Results A total of seven studies (535 patients) were included in this meta‐analysis. Pooled analysis showed that the operative time of TL was significantly reduced in the SC group (MD, −63.2; 95% CI, −106.0 to −20.4). Moreover, the SC group had a lower incidence of pharyngocutaneous fistula (OR = 0.38; 95% CI, 0.18 to 0.83; P = .016) and hospital stay (MD, −2.9; 95% CI, −5.6 to −0.1). The incidence of postoperative surgical site infection (OR = 0.41; 95% CI, 0.02 to 8.73; P = .565) was comparable between the two groups. Conclusion Based on these results, SC may be a useful option for patients who need TL.

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“…Moreover, in group A, more patients had been previously treated with RT (50% of patients received exclusive RT, 26.1% CRT) rather than in group B (28% received exclusive RT, 33.8% CRT). Therefore, in the stapler group, a total of 76.1% patients were subjected to RT, which is another well‐known risk factor for development of a fistula 21,22 …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, in the stapler group, a total of 76.1% patients were subjected to RT, which is another well-known risk factor for development of a fistula. 21,22 In the literature, the incidence of PCF after TL ranges from 13% to 38%, from 10% to 16% after primary treatment and from 12% to 38% after salvage surgery. 23 In our retrospective study, the fistula incidence was 18.4% (21/114 patients).…”

Section: Discussionmentioning

confidence: 99%

Stapler Use in Salvage Total Laryngectomy: A Useful Tool?

et al. 2020

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Objectives/Hypothesis To analyze stapler benefits in salvage total laryngectomy in terms of surgical time, hospitalization length, oral feeding time, and occurrence of pharyngocutaneous fistula, and to evaluate risk factors for its onset. Study Design Retrospective analysis. Methods One hundred fourteen patients affected by endolaryngeal squamous cell carcinoma who underwent salvage total laryngectomy following primary treatment failure were reviewed. We divided patients into two groups based on type of pharyngeal suture performed: mechanical suture with stapler (group A) and manual suture (group B). These two groups were compared for surgical time, start of oral feeding, hospitalization length, surgical margins and pharyngocutaneous fistula incidence considering its relationship with diabetes mellitus, nutritional status, primary treatment, and neck dissection. Results In group A and group B, oral feeding restarting time was 15 ± 9.33 versus 20.03 ± 13.81 days, hospitalization was 17.63 ± 10.08 versus 23.72 ± 14.29 days, and surgery lasted 268.39 ± 76.93 versus 294.26 ± 140.58 minutes, respectively (P < .05). Surgical margins resulted infiltrated in two patients (4.3%) in group A and 12 patients in group B (17.6%) (P = .03). Twenty‐one patients (18.4%) presented with pharyngocutanoeus fistula. In group A and group B the incidence of fistula was 15.2% and 20.6%, respectively (P = .468). Fistula occurred in 7 of 18 diabetic patients (38.9%) and 14 of 96 (14.6%) nondiabetic patients (P = .015). Nineteen fistulas (90.5%) occurred in patients who had undergone previous radiation treatment (P = .013). Conclusions Using a stapler shortened operative time and hospitalization, while also providing a faster restart of oral feeding. Moreover, mechanical pharyngeal suture seems to decrease fistula rate even though its prevention role in salvage laryngectomy should be confirmed by further studies. Level of Evidence 4 Laryngoscope, 131:E473–E478, 2021

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Prediction of pharyngocutaneous fistula and survival after salvage laryngectomy for laryngohypopharyngeal carcinoma

Cited by 10 publications

References 35 publications

Twenty-year experience with salvage total laryngectomy: lessons learned

Twenty-year experience with salvage total laryngectomy: lessons learned

Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: A systematic review and meta‐analysis

Stapler Use in Salvage Total Laryngectomy: A Useful Tool?

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