Pectoralis major myofascial interposition flap prevents postoperative pharyngocutaneous fistula in salvage total laryngectomy.

Anschuetz, Lukas; Nisa Hernandez, Lluis; Eliçin, Olgun; Bojaxhiu, Beat; Caversaccio, Marco; Giger, Roland (2016). Pectoralis major myofascial interposition flap prevents postoperative pharyngocutaneous fistula in salvage total laryngectomy. European archives of oto-rhino-laryngology, 273(11), pp. 3943-3949. Springer 10.1007/s00405-016-4049-7

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Pharyngocutaneous fistula (PCF) is the most cumbersome complication after salvage total laryngectomy (STL) in patients who have been previously irradiated for laryngeal or hypopharyngeal cancer. To assess the fistula rate, risk factors and effects of primary closure with and without pectoralis major myofascial interposition flap (PMMIF) on fistula formation, we conducted a retrospective review. We identified 48 patients from 2004 to 2013 who underwent STL after failure of primary curative (chemo)radiotherapy in laryngeal or hypopharyngeal cancer. Details of risk factors for PCF formation, other postoperative complications and general outcome data were analyzed. Ten (20.8 %) out of 48 patients underwent STL with PMMIF closure. Patient and tumor features were not different between the groups with or without PMMIF closure. PCF rates were 0 and 42.1 % in patients with and without PMMIF, respectively (p = 0.002). Other operative complications were similar. We identified prior neck irradiation to be a risk factor for fistula formation (p = 0.04). Patients without PCF had a statistically significant reduction of average hospital stay (20 vs. 56 days; p = 0.001). Analysis of fistula management revealed 50 % of PCF to be closed secondarily by a pectoralis major myocutaneous flap. Over one-third of fistulae persisted despite attempted surgical closure in some cases. PMMIF is useful to prevent PCF in STL following (chemo)radiotherapy. Neck irradiation during primary treatment is a risk factor for PCF formation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)

UniBE Contributor:

Nisa Hernandez, Lluis; Eliçin, Olgun; Bojaxhiu, Beat; Caversaccio, Marco and Giger, Roland

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0937-4477

Publisher:

Springer

Language:

English

Submitter:

Beatrice Scheidegger

Date Deposited:

07 Apr 2017 15:23

Last Modified:

07 Apr 2017 15:23

Publisher DOI:

10.1007/s00405-016-4049-7

PubMed ID:

27107580

Uncontrolled Keywords:

Pectoralis major myofascial interposition flap; Pharyngocutaneous fistula; Salvage laryngectomy; Salvage surgery

BORIS DOI:

10.7892/boris.92809

URI:

https://boris.unibe.ch/id/eprint/92809

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