Use of pectoralis major myofascial flap on the prevention of pharyngocutaneous fístula in salvage laryngectomy after chemoradiotherapy

Iglesias-Moreno, Mari-Cruz; Sarrió-Solera, Pablo; López-Salcedo, Maria Andrea; Poch-Pérez-Botija, Adriana; Serrano, Manuel Gómez; Gimeno-Hernández, Jesús; Poch-Broto, Joaquín

doi:10.1080/00016489.2019.1649721

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…In our study, only one patient developed a fistula after total laryngectomy with PMMC flap due to prior bilateral chest radiation therapy for breast cancer. Iglesias-Moreno MC et al also reported similar PCF rates in salvage laryngectomy with PMMC flap [16]. We had three patients with large PCF after salvage total laryngectomy, most probably due to radiation-induced microvascular injury leading to poor wound healing.…”

Section: Discussionsupporting

confidence: 55%

Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience

Bathula

Stern

Ross

et al. 2021

Cureus

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Section: Discussionsupporting

confidence: 55%

Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience

Bathula

Stern

Ross

et al. 2021

Cureus

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“…Articles were predominantly excluded on the basis that they did not specify the difference in PCF rates between patients with and without flap reconstruction ( n = 5), 19–21 or between salvage and primary laryngectomy procedures ( n = 9) 22,23 . In total, 31 studies 20–50 were selected for inclusion 24,26–28,30,32–34,36,40,41,46,50–52 including seven articles derived from the previous review 25,27,38,40,43,44,49 …”

Section: Resultsmentioning

confidence: 99%

“…In the 27 studies using a comparative cohort, the mean MINORS score was 14.2/24 (range 8–18), implying a moderate to high risk of bias across all studies. One study documented an a priori sample size calculation, 26 and numerous studies did not compare contemporary patients, reporting an older cohort in the primary closure group, before a change in local practices meant the vascularized flap group was derived from a more modern collection of patients 22,25,32,44,48 . Similarly, there was a moderate to high risk of bias in the four non‐comparative studies, with a mean score of 6.75 (range 5–9).…”

Section: Resultsmentioning

confidence: 99%

Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta‐analysis

Williamson,

Shah,

Benaran

et al. 2024

The Laryngoscope

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ObjectiveSalvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.2% after primary and flap‐assisted closure respectively. We aim to better define the role of vascularized flaps after salvage laryngectomy by performing an updated review comparing the rate of PCF in those undergoing primary or vascularized flap‐assisted closure.Data SourcesPubmed/Medline, CINAHL, and CENTRAL.Review MethodsAn updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta‐analysis of odds ratios (OR) and pooled proportions were conducted.ResultsLiterature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I2 = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I2 = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I2 = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I2 = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on‐lay and patch closure compared to primary closure techniques. Network meta‐analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure.ConclusionThe updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap‐assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 2024

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“…After scrupulous full-text review, 24 articles published from 2005 to 2020 met full selection criteria for qualitative data pooling. 12,15,25-46 The 90 omitted articles, with reasons for exclusion, are listed in Appendix 2 (available online).…”

Section: Resultsmentioning

confidence: 99%

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta‐analysis

Cabrera

Jones

Parker

et al. 2020

Otolaryngol.--head neck surg.

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Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.

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Use of pectoralis major myofascial flap on the prevention of pharyngocutaneous fístula in salvage laryngectomy after chemoradiotherapy

Cited by 6 publications

References 20 publications

Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience

Role of Pectoralis Major Myocutaneous Flap in Laryngectomy Surgery: Single Surgeon Experience

Vascularized Tissue to Reduce Fistula After Salvage Total Laryngectomy: A Network Meta‐analysis

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta‐analysis

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