Defining the Low-risk Salvage Laryngectomy-A Single-center Retrospective Analysis of Pharyngocutaneous Fistula

Overview

Journal Laryngoscope Investig Otolaryngol

Publisher Wiley

Specialty Otorhinolaryngology

Date 2018 May 4

PMID 29721544

Citations 3

Authors

Sarju S Vasani

Daniel Youssef

Charles Lin

Annabelle Wellham

Robert Hodge

Affiliations

Soon will be listed here.

Abstract

Objectives: Salvage total laryngectomies (STL) are not a homogeneous group. Most will fall into two groups: i) Patients with previous AJCC stage I/II larynx cancer who have had radiotherapy to the larynx only (STL-LOR), or ii) Patients who have had previous AJCC stage III/IV larynx cancer and subsequent radiotherapy to the larynx and draining nodal basins with concurrent cisplatin chemotherapy (STL-CRT). We aimed to compare PCF rates following STL in these two groups.

Methods: A retrospective review of the department's cohort between January 2010 and August 2015 was conducted.

Results: Seventy-seven patients underwent total laryngectomy for larynx cancer between January 2010 and August 2015. There were 10 post-laryngectomy fistulas (13.0%). Three of these occurred in the 38 patients undergoing primary total laryngectomy (PTL), and seven in the 39 patients undergoing STL, rates of 7.9% and 17.9%, respectively. Twenty-two patients had received radiation to the larynx alone without chemotherapy (STL-LOR) for initial Stage I/II disease. Eleven patients had received laryngeal and neck irradiation plus cisplatin chemotherapy (STL-CRT) for initial stage III/IV disease. Of the 22 STL-LOR patients, two developed PCF (9.1%). Of the 11 STL-CRT patients, five developed PCF. There was no difference in the rate of PCF between PTL and STL-LOR. There was a statistically significant increase in PCF in STL-CRT versus PTL ( = .009) and in PCF in STL-CRT versus STL-LOR ( = .027).

Conclusion: Salvage laryngectomies are often treated as a homogenous group. We demonstrate that PCF rates vary significantly depending on preoperative radiation fields and the use of chemotherapy.

Level Of Evidence: 2b.

Citing Articles

Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer.

Brown T, Edwards A, Pashley A, Lehn B, Vasani S, Hodge R Eur Arch Otorhinolaryngol. 2023; 280(12):5531-5538.

PMID: 37535080 PMC: 10620302. DOI: 10.1007/s00405-023-08139-x.

Evaluation of the Incidence of Pharyngocutaneous Fistula after Total Laryngectomy.

Motiee Langaroudi M, Jafari M, Safari R, Sadeghi Ivraghi M, Mazarei A Iran J Otorhinolaryngol. 2023; 35(128):141-146.

PMID: 37251293 PMC: 10209815. DOI: 10.22038/IJORL.2023.69853.3370.

Total Laryngectomy: A Review of Surgical Techniques.

Chotipanich A Cureus. 2021; 13(9):e18181.

PMID: 34707956 PMC: 8531883. DOI: 10.7759/cureus.18181.

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