Vascularized tissue to reduce fistula following salvage total laryngectomy: A systematic review

Vinidh Paleri, Mike Drinnan, Michiel W.M. Van Den Brekel, Michael L. Hinni, Patrick J. Bradley, Gregory T. Wolf, Remco De Bree, Johannes J. Fagan, Marc Hamoir, Primož Strojan, Juan P. Rodrigo, Kerry D. Olsen, Phillip K. Pellitteri, Ashok R. Shaha, Eric M. Genden, Carl E. Silver, Carlos Suárez, Robert P. Takes, Alessandra Rinaldo, Alfio Ferlito

Research output: Contribution to journalArticle

56 Scopus citations

Abstract

Objectives/Hypothesis Pharyngocutaneous fistulae (PCF) are known to occur in nearly one-third of patients after salvage total laryngectomy (STL). PCF has severe impact on duration of admission and costs and quality of life and can even cause severe complications such as bleeding, infection and death. Many patients need further surgical procedures. The implications for functional outcome and survival are less clear. Several studies have shown that using vascularized tissue from outside the radiation field reduces the risk of PCFs following STL. This review and meta-analysis aims to identify the evidence base to support this hypothesis. Data Sources English language literature from 2004 to 2013 Review Methods We searched the English language literature for articles published on the subject from 2004 to 2013. Results Adequate data was available to identify pooled incidence rates from seven articles. The pooled relative risk derived from 591 patients was 0.63 (95% CI: 0.47 to 0.85), indicating that patients who have flap reconstruction/reinforcement reduced their risk of PCF by one-third. Conclusion This pooled analysis suggests that there is a clear advantage in using vascularized tissue from outside the radiation field in the laryngectomy defect. While some studies show a clear reduction in PCF rates, others suggest that the fistulae that occur are smaller and rarely need repair. Laryngoscope, 124:1848-1853, 2014

Original languageEnglish (US)
Pages (from-to)1848-1853
Number of pages6
JournalLaryngoscope
Volume124
Issue number8
DOIs
StatePublished - Aug 2014

Keywords

  • Salvage laryngectomy
  • free flaps
  • pedicled flaps
  • pharyngocutaneous fistula
  • reconstruction
  • recurrent laryngeal cancer

ASJC Scopus subject areas

  • Otorhinolaryngology

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    Paleri, V., Drinnan, M., Van Den Brekel, M. W. M., Hinni, M. L., Bradley, P. J., Wolf, G. T., De Bree, R., Fagan, J. J., Hamoir, M., Strojan, P., Rodrigo, J. P., Olsen, K. D., Pellitteri, P. K., Shaha, A. R., Genden, E. M., Silver, C. E., Suárez, C., Takes, R. P., Rinaldo, A., & Ferlito, A. (2014). Vascularized tissue to reduce fistula following salvage total laryngectomy: A systematic review. Laryngoscope, 124(8), 1848-1853. https://doi.org/10.1002/lary.24619