Pharyngcutaneous fistula after total laryngectomy: treatment modalities and our experiences

Yıl 2022, Cilt: 4 Sayı: 3, 300 - 304, 26.07.2022

Tuncay Tunçcan Caner Kılıç

https://doi.org/10.38053/acmj.1094950

Öz

Aim: The aim of this study is to share our experience and treatment modalities in pharyngocutaneous fistulas that can be seen after primary and post-radiotherapy salvage total laryngectomy.
Material and Method: The records of patients who underwent total laryngectomy in our clinic between February 2012 and December 2021 were reviewed retrospectively. The patients’ age, preoperative radiotherapy history, postoperative fistula development, gastrostomy opening, treatment modality, and hospital stay were examined.
Results: A total of 115 patients, 81 of whom were primary and 34 of whom had a history of radiotherapy, were evaluated in the study. Pharyngocutaneous fistula developed in a total of 20 patients in 10 primary patients and 10 patients with a history of preoperative radiotherapy. The mean hospital stay was 10 days for patients who did not develop fistula. The mean hospital stay was 27 days between days 21 and 36 in primary patients with fistula, and it was 46 days between days 34 and 68 in patients with a history of radiotherapy who developed fistula. While only 1 of the primary patients underwent reconstruction with a pectoralis major muscle flap because the fistula did not close despite local dressing and local skin flaps, this number was 7 in patients with a history of radiotherapy.
Conclusion: The presence of a history of radiotherapy before total laryngectomy increases the risk of laryngocutaneous fistula development, increases the need for myocutaneous flaps, and increases the length of hospital stay, resulting in increased comorbidity. Pharyngocutaneous fistula development is neither an important comorbidity nor religion.

Anahtar Kelimeler

Total laryngectomy, radiotherapy, salvage laryngectomy, pharyngocutaneous fistula

Kaynakça

• National Cancer Institute. SEER: cancer stat facts: larynx cancer. 2018. Available at: http://seer.cancer.gov/statfacts/html/laryn.html. Accessed February 10, 2018.
• Megwalu UC, Sikora AG. Survival outcomes in advanced laryngeal cancer. JAMA Otolaryngol Head Neck Surg 2014; 140: 855–60
• Mo HL, Li J, Yang X, et al. Transoral laser microsurgery versus radiotherapy for T1 glottic carcinoma: a systematic review and metaanalysis. Lasers Med Sci 2017; 32: 461-7
• Forastiere AA, Ismaila N, Lewin JS, et al. Use of larynx preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2018; 36: 1143–69
• Smee RI, Williams JR, Broadley K, Bridger GP. Early glottic carcinoma treated by radiotherapy: defining a populationfor surgical salvage. Laryngoscope 2013; 123: 171
• M. Busonı, A. Deganello, O. Gallo. Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities. Acta Otorhinolaryngol Ital 2015; 35: 400-5
• Kirchner JA. Pathways and pitfalls in partial laryngectomy. Ann Otol Rhinol Laryngol 1984; 93: 301-5
• Erdag MA, Arsianoglu S, Onal K, Songu M, Tuylu OA. Pharyngocutaneous fistula following total laryngectomy: multivariate analysis of risk factors. Eur Arch Otorhinolaryngol 2013; 270: 173-9
• Emerick KS, Tomycz L, Bradford CR et al. Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation. Otolaryngol Head Neck Surg 2009; 140: 386–90
• Deganello A, Gallo O, De Cesare JM, et al. Supracricoid partial laryngectomy as salvage surgery for radiation therapy failure. Head Neck 2008; 30 :1064-71
• Gourin CG, Conger BT, Sheils WC, Biladeu PA, ColemanTA, Porubsky ES. The effect of treatment on survival in patients with advanced laryngeal carcinoma. Laryngoscope 2009; 119: 1312
• Cohen JI, Clayman GL. Unit IV: laryngopharyngeal operations. In: Atlas of head & neck surgery. Philadelphia: Elsevier; 2011.