The Impact of Pharyngeal Repair Time and Suture Frequency on the Development of Pharyngocutaneous Fistula After Total Laryngectomy

Objectives. A pharyngocutaneous fistula (PCF) following total laryngectomy is associated with increased morbidity and severe life threatening complications. We aimed to review our experience with the PCF following total laryngectomy and determine the impact of previously reported risk factors on the development of PCF in our patients.Methods. The medical records of 20 patients who had a total laryngectomy operation were retrospectively analyzed. The association between the proposed risk factors and the incidence of the PCF was investigated.Results. Comparison of the suture techniques used for the closure of the pharynx (either continuous Cushing type or interrupted) yielded that primary interrupted sutures had a significantly higher incidence of PCF formation(p<0.05). Although it was not statistically significant, diabetes mellitus was also associated with increased PCF formation(p>0.05). No significant difference was observed between the PCF and non-PCF groups in terms of other proposed risk factors(p>0.05). Conclusions. The main risk factor associated with PCF was found to be the type of pharyngeal closure technique. A vertical closure with a Cushing type continuous suture may be more successful than interrupted sutures in preventing a PCF.

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Time interval between (chemo)radiotherapy and subsequent laryngectomy is not prognostic for post operative complications and survival

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-020-06384-y ◽

2020 ◽

Author(s):

Thomas F. Pézier ◽

Johannes A. Rijken ◽

Bernard M. Tijink ◽

W. Weibel Braunius ◽

Remco de Bree

Keyword(s):

Overall Survival ◽

Total Laryngectomy ◽

Medical Center ◽

Time Interval ◽

Pharyngocutaneous Fistula ◽

Retrospective Case ◽

Rate Risk ◽

Swallowing Difficulties ◽

One Year ◽

The Impact

Abstract Purpose Pharyngocutaneous fistula (PCF) formation and swallowing difficulties are common and troublesome complications following total laryngectomy (TL). Prior (chemo)radiotherapy ((C)RT) is thought to be a risk factor for these complications, but there is conflicting evidence as to whether the time interval between (C)RT and TL is important. The impact of time interval on these complications and also its impact on overall survival are investigated. Methods This is a retrospective case note review of all patients undergoing TL at the University Medical Center, Utrecht, The Netherlands over the 10-year period from January 2008 to December 2017. The cohort was split into those who underwent TL within a year of finishing (C)RT and those longer than 1 year. Results One hundred and twenty-six patients (108 males, 18 females), with a mean age of 66 underwent total laryngectomy after prior (C)RT in the study period. Overall 5-year survival was 35% with a median follow-up of 30 months. Fifty-four patients underwent laryngectomy within a year of their (C)RT versus 72 patients who had a time interval of more than one year. No differences in PCF rate, risk of dilatation or overall survival could be found between the two groups. Conclusions In this modern cohort, time interval between (C)RT and surgery did not impact PCF rate, risk of dilatation or overall survival.

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A review of pharyngeal mucosal closure technique in total laryngectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185303 ◽

2018 ◽

Vol 5 (1) ◽

pp. 145

Author(s):

Gopu Govindasamy ◽

Subbiah Shanmugam ◽

Arul Murugan

Keyword(s):

Medical Records ◽

Total Laryngectomy ◽

Salvage Surgery ◽

Pharyngocutaneous Fistula ◽

Closure Technique ◽

Carcinoma Of The Larynx ◽

The Impact ◽

Salvage Laryngectomy ◽

Radiotherapy Failure ◽

Hospital Center

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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Prevention of pharyngocutaneous fistula in salvage total laryngectomy: role of the pectoralis major flap and peri-operative management

The Journal of Laryngology & Otology ◽

10.1017/s0022215118000178 ◽

2018 ◽

Vol 132 (3) ◽

pp. 246-251 ◽

Cited By ~ 6

Author(s):

P Sittitrai ◽

C Srivanitchapoom ◽

D Reunmakkaew

Keyword(s):

Total Laryngectomy ◽

Operative Management ◽

Incidence Rates ◽

Pectoralis Major ◽

Control Group ◽

Pharyngocutaneous Fistula ◽

Pectoralis Major Flap ◽

Operative Care ◽

Fistula Rate ◽

The Impact

AbstractObjective:This study aimed to evaluate the impact of an onlay pectoralis major flap in reducing the incidence of pharyngocutaneous fistula after salvage total laryngectomy and determine the complications of pectoralis major flap reconstruction.Methods:A retrospective study was conducted of consecutive patients who underwent salvage total laryngectomy between 1995 and 2016. The pharyngeal defects were primarily closed with or without the pectoralis major flap.Results:Of 64 patients, 34 had primary pharyngeal closure alone (control group) and 30 received an onlay pectoralis major flap (pectoralis major flap group). The overall fistula rate was 15.6 per cent, with 17.6 per cent occurring in the control group and 13.3 per cent in the pectoralis major flap group (p = 0.74). The incidence rates of voice failure (p = 0.02) and shoulder disability (p < 0.001) were significantly higher in the pectoralis major flap group.Conclusion:The pectoralis major flap in salvage total laryngectomy did not decrease the pharyngocutaneous fistula rate, and the incidence of flap-related complications was high. Appropriate surgical technique and post-operative care may reduce the incidence of pharyngocutaneous fistula.

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The Impact of Pharyngeal Repair Time and Number of Sutures on Development of Pharyngocutaneous Fistula

Otolaryngology ◽

10.1177/0194599814541629a163 ◽

2014 ◽

Vol 151 (1_suppl) ◽

pp. P189-P190

Author(s):

Umit Taskin ◽

Salih Aydin ◽

Israfil Orhan ◽

Bengul Altas ◽

Kadir Yucebas ◽

...

Keyword(s):

Repair Time ◽

Pharyngocutaneous Fistula ◽

The Impact

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Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-017-0233-z ◽

2017 ◽

Vol 46 (1) ◽

Cited By ~ 6

Author(s):

Nicole L. Lebo ◽

Lisa Caulley ◽

Hussain Alsaffar ◽

Martin J. Corsten ◽

Stephanie Johnson-Obaseki

Keyword(s):

Total Laryngectomy ◽

Pharyngocutaneous Fistula ◽

Patient Cohort

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Postlaryngectomy Pharyngocutaneous Fistula: Incidence, Predisposing Factors, and Therapy

Otolaryngology ◽

10.1016/j.otohns.2005.07.025 ◽

2005 ◽

Vol 133 (5) ◽

pp. 689-694 ◽

Cited By ~ 76

Author(s):

Jacopo Galli ◽

Eugenio De Corso ◽

Mariangela Volante ◽

Giovanni Almadori ◽

Gaetano Paludetti

Keyword(s):

Risk Factor ◽

Total Laryngectomy ◽

Radical Neck Dissection ◽

Predisposing Factors ◽

Spontaneous Closure ◽

Pharyngocutaneous Fistula ◽

Systemic Diseases ◽

Surgical Closure ◽

Number Of Factors ◽

Wait And See

OBJECTIVE: The pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy, and its etiology is not well understood yet. The aim of our study was to evaluate predisposing factors, incidence, and management of this complication. STUDY DESIGN AND SETTING: This was a retrospective study of 268 patients who underwent total laryngectomy in our clinic (January 1990-December 2001). A number of factors potentially predisposing to PCF formation were evaluated. RESULTS: A PCF was observed in 16% of patients. Systemic diseases, previous radiotherapy, supraglottic origin of tumor, and concurrent radical neck dissection were significantly associated with PCF. Spontaneous closure was noted in 28 patients, whereas a surgical closure was necessary in 15 patients. CONCLUSIONS: In presence of a specific risk factor, PCF can be expected; nevertheless, its prevention remains very difficult. Moreover, given the high percentage of spontaneous closure, we suggest the “wait and see” approach for 28 days before proceeding with a surgical approach.

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Pharyngocutaneous Fistula after Total Laryngectomy: Incidence, Cause, and Treatment

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949410301010 ◽

1994 ◽

Vol 103 (10) ◽

pp. 801-805 ◽

Cited By ~ 64

Author(s):

George Papazoglou ◽

George Terzakis ◽

George Doundoulakis ◽

George Dokianakis

Keyword(s):

Total Laryngectomy ◽

Major Complication ◽

Predisposing Factors ◽

Morbidity And Mortality ◽

Red Cross ◽

Pharyngocutaneous Fistula ◽

Common Complication ◽

Methods Of Treatment

Postoperative pharyngocutaneous fistula is a major complication of total laryngectomy that prolongs the short hospitalization of 2 to 3 weeks to many weeks or even months. It is a common complication that increases the morbidity and mortality of the procedure. In the Department of Otolaryngology of the Red Cross Hospital of Athens, 310 patients underwent total laryngectomy from January 1980 through December 1989. Twenty-eight patients developed a fistula (incidence 9%). The incidence, predisposing factors, and methods of treatment of this complication are analyzed and discussed.

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The impact of Radiotherapy on Swallowing and Speech in Patients who Undergo total Laryngectomy

Otolaryngology ◽

10.1016/j.otohns.2008.08.023 ◽

2008 ◽

Vol 139 (6) ◽

pp. 792-797 ◽

Cited By ~ 21

Author(s):

Carmen de Casso ◽

Nicholas J. Slevin ◽

Jarrod J. Homer

Keyword(s):

Total Laryngectomy ◽

Chart Review ◽

Detrimental Effect ◽

Definitive Treatment ◽

Soft Diet ◽

Carcinoma Of The Larynx ◽

Voice Development ◽

The Impact ◽

Single Modality

Objectives Quality of life studies have shown no detrimental effect with radiotherapy (RT) in patients who have a total laryngectomy. We wished to determine the effect of RT (initial or postoperative) specifically on the swallowing and voice function in patients treated by total laryngectomy (TL) for carcinoma of the larynx. Design Multicenter chart review. Setting Multicenter study in the Greater Manchester and Lancashire area. Participants A total of 121 postlaryngectomy patients all of whom had completed definitive treatment at least 6 months before this study. Twenty-six patients had total laryngectomy as a single modality treatment and 95 had total laryngectomy and radiotherapy. Main Outcome Measures Swallowing (solid food, soft diet or fluid/PEG) and voice development. Results Swallowing was better in the group who had no radiotherapy ( P = 0.0037). There was no difference in voice function between the two groups. We also demonstrated that females had a worse swallowing outcome ( P = 0.0101), as did advanced nodal stage ( P = 0.001). Conclusions RT adversely affects the swallowing results but not the speech results after TL when given either as initial treatment or postoperatively. This should be kept in mind in the decision-making process in the treatment of patients with carcinoma of the larynx.

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