A review of pharyngeal mucosal closure technique in total laryngectomy
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20185303Keywords:
Laryngectomy, Pharyngocutaneous fistula, Pharyngeal mucosal closureAbstract
Background: The purpose of this retrospective analysis was to review our single institute based experience with the pharyngocutaneous fistula following total laryngectomy and to determine the impact of pharyngeal closure technique in the development of PCF in our patients.
Methods: The medical records of the patients, who underwent total laryngectomy for squamous cell carcinoma of the larynx and hypopharynx in Government Royapettah Hospital, center for oncology between January 2010 and December 2017, were retrospectively reviewed.
Results: 26 patients were included in the study of which 25 were male and 1 was female. Mean age of the patients were 58 years. Horizontal closure was done in 9 patients (35%) and T closure was done in 17 patients (65%). PCF was observed in 1 of 9 patients in horizontal closure. Remaining 17 patients underwent T closure of whom 8 patients developed PCF (p=0.06). Eight out of 18 patients (44%) developed PCF after salvage surgery after radiotherapy failure, Remaining 8 patients underwent primary laryngectomy for advanced stage cancers with cartilage involvement, of whom 1 patient developed PCF (12.5%) (p=0.11). In salvage laryngectomy (n=18), 1 of 6 cases developed PCF in horizontal closure and 7 of 12 cases in T closure technique (p=0.09).
Conclusions: The incidence of fistula in our study was 34%. Horizontal closure was associated with decreased incidence of PCF when compared to ‘T’ closure of the defect. Prior radiotherapy had increased incidence of PCF.
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References
Wolf GT, Fisher SG, Hong WK, Hillman R, Spaulding M, Laramore GE, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324(24):1685-10.
Nakayama M, Laccourreye O, Holsinger F C, Okamoto M, and Hayakawa K. Functional organ preservation for laryngeal cancer: past, present and future. Japanese J Clin Oncol. 2012;42(3):155–60.
Paydarfar JA, Birkmeyer NJ. Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg. 2006;132:67-72.
Morton RP, Mehanna H, Hall FT, McIvor NP. Prediction of pharyngocutaneous fistulas after laryngectomy. Otolaryngology— Head and Neck Surg. 2007;136(4):S46–9.
Ganly I, Patel S, Matsuo J, Singh B, Kraus D, Boyle J, et al. Postoperative complications of salvage total laryngectomy. Cancer. 2005;103(10):2073-81.
Jatin Shah’s Head and Neck surgery and oncology, fourth edition –chapter 10, 424; 2012.
Furuta Y, Homma A, Oridate N, Suzuki F, Hatakeyama H, Suzuki K, et al. Surgical complications of salvage total laryngectomy following concurrent chemoradiotherapy. Int J Clin Oncol. 2008;13:521.
Hier M, Black MJ, Lafond G. Pharyngo-cutaneous fistulas after total laryngectomy: incidence, etiology and outcome analysis. J Otolaryngol. 1993;22:164-6.
Shah AK, Ingle MV, Shah KL. Some thoughts on prevention of postoperative salivary fistula. J post grad Med. 1985;31:95-7.
Stell PM, Cooney TC. Management of fistulae of the head and neck after radical surgery. J Laryngol Otol. 1974;88:819‐34.
Qureshi SS, Chaturvedi P, Pai PS, Chaukar DA, Deshpande MS, Pathak KA, et al. A prospective study of pharyngocutaneous fistulas following total laryngectomy. J Cancer Res Ther. 2005;1:51‐6.
Naghibzadeh M, Ramin Z, Amir MNM, Farsi BMM. Using a sternocleidomastoid muscle flap to prevent postoperative pharyngocutaneous fistula after total laryngectomy: a study of 88 cases. Ear Nose Throat J. 2014;93(8):362–5.
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