Stapler-Assisted Pharyngeal Closure After Total Laryngectomy: A Systematic Review and Meta-Analysis

Chiesa‐Estomba, Carlos Miguel; Mayo‐Yáñez, Miguel; Palacios-García, José María; Lechien, Jérôme R.; Viljoen, G. J.; Karkos, Petros D.; Barillari, Maria Rosaria; González-García, José Ángel; Sistiaga-Suárez, Jon Alexander; González‐Botas, Jesús Herranz; Ayad, Tareck; Ferlito, Alfio

doi:10.1007/s40487-022-00193-5

Cited by 7 publications

(11 citation statements)

References 24 publications

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“…There are three systematic reviews comparing manual and stapler closure [ 14 – 16 ]. Aires et al included four studies [ 16 ], Lee et al [ 15 ] included seven studies, and Chiesa et al [ 14 ] included eight.…”

Section: Resultsmentioning

confidence: 99%

Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review

et al. 2023

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Introduction The most common early postoperative complication after total laryngectomy (TL) is pharyngocutaneous fistula (PCF). Rates of PCF are higher in patients who undergo salvage TL compared with primary TL. Published meta-analyses include heterogeneous studies making the conclusions difficult to interpret. The objectives of this scoping review were to explore the reconstructive techniques potentially available for primary TL and to clarify which could be the best technique for each clinical scenario. Methods A list of available reconstructive techniques for primary TL was built and the potential comparisons between techniques were identified. A PubMed literature search was performed from inception to August 2022. Only case–control, comparative cohort, or randomized controlled trial (RCT) studies were included. Results A meta-analysis of seven original studies showed a PCF risk difference (RD) of 14% (95% CI 8–20%) favoring stapler closure over manual suture. In a meta-analysis of 12 studies, we could not find statistically significant differences in PCF risk between primary vertical suture and T-shaped suture. Evidence for other pharyngeal closure alternatives is scarce. Conclusion We could not identify differences in the rate of PCF between continuous and T-shape suture configuration. Stapler closure seems to be followed by a lower rate of PCF than manual suture in those patients that are good candidates for this technique.

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Section: Resultsmentioning

confidence: 99%

Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review

et al. 2023

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“…• Timing of feed initiation -early feed initiation was found to have slightly higher PCF rates 18 ; No significant difference between early and late feeds 8,11,15 . • The use of stapler for pharyngeal closure equivocally led to lower rates of PCF with Stapler usage 9,23,24 .…”

Section: Discussionmentioning

confidence: 99%

“…Four meta-analyses (16.6%) focused on the timing of oral feed initiation on PCF 8,11,15,18 . Three meta-analyses (12.5%) focused on using stapler for pharyngeal closure on PCF 9,23,24 . Two meta-analyses determined the risk of PCF following various types of pharyngeal reconstruction 1,2 .…”

Section: Research Questionmentioning

confidence: 99%

Lacunae in meta-analyses of Pharyngocutaneous fistula after laryngectomy: A bibliometric study

Rao,

Arora,

Dange

et al. 2023

Preprint

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Objective -The objective of this study was to systematically assess the meta-analyes to determine the lacunae in the literature for PCF following laryngectomy. Methods – Bibliometric analysis on Meta-analyses on PCF after total laryngectomy for laryngeal cancer in PubMed Database. Results – twenty-four meta-analyses were considered eligible and chosen for analysis, Six meta-analyses (25%) focused on the risk factors for PCF in TL. Four meta-analyses (16.6%) on the role of onlay flap. Four meta-analyses (16.6%) focused on the timing of feed initiation. Three meta-analyses (12.5%) on using stapler for pharyngeal closure. Two meta-analyses on types of pharyngeal reconstruction. Other meta-analysis analysed the use of salivary bypass tubes, the method of pharyngeal closure, organ preservation protocols on PCF, primary and secondary TEP and the effect of non-surgical treatment on PCF. Conclusion - Despite the plenty of published meta-analysis, there is a lack of scrutiny on some critical aspects of PCF.

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“…In stapler‐assisted laryngectomy a linear stapler is used for pharyngeal closure and concomitant excision of the larynx. The reported advantages of this technique are reduced rate of pharyngocutaneous fistula (PCF), reduced surgical time and length of hospital stay, and decreased time before safe resumption of deglutition 3–5 …”

Section: Introductionmentioning

confidence: 99%

“…The reported advantages of this technique are reduced rate of pharyngocutaneous fistula (PCF), reduced surgical time and length of hospital stay, and decreased time before safe resumption of deglutition. [3][4][5] Nevertheless, in the stapler-assisted technique, failure to visualize the tumor during resection may be associated with a potential risk of histologically positive margins. Specifically, the use of the stapler for pharyngeal closure is not indicated for tumors with extension to suprahyoid epiglottis, vallecula, pyriform sinus, and postcricoid extension with a potential pharyngeal spread.…”

Section: Introductionmentioning

confidence: 99%

Hybrid primary puncture in stapler‐assisted total laryngectomy

Galli,

Perna,

Rossi

et al. 2023

Head & Neck

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In Video S1, a new surgical technique for hybrid primary tracheoesophageal (TE) puncture in stapler‐assisted total laryngectomy is shown. The video describes the surgical steps of the procedure and illustrates some tips and tricks. The procedure incorporates an upper mini‐pharyngotomy to enable retrograde placement of the voice prosthesis (VP), eliminating the need for rigid esophagoscopy. This has made it possible to exploit, without additional risks, the potential of the stapler combined with primary TE puncture and VP placement. In our experience, this hybrid procedure in stapler‐assisted total laryngectomy is not related to adverse events such as pharyngocutaneous fistula (PCF), hypertonicity, and functional complications. Therefore, it can be considered a valid technique that allows for easy insertion of a primary voice prosthesis also in case of mechanical sutures.

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Stapler-Assisted Pharyngeal Closure After Total Laryngectomy: A Systematic Review and Meta-Analysis

Cited by 7 publications

References 24 publications

Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review

Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review

Lacunae in meta-analyses of Pharyngocutaneous fistula after laryngectomy: A bibliometric study

Hybrid primary puncture in stapler‐assisted total laryngectomy

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