title: Comparison of complication rates associated with stapling and traditional suture closure after total laryngectomy for advanced cancer.
abstract: We conducted a retrospective, matched-cohort, case-control study to compare complication rates associated with two wound closure procedures-stapling vs. traditional hand suturing-following total laryngectomy. Our study population was made up of 42 consecutively presenting patients-38 men and 4 women, aged 34 to 92 years (mean: 60.3) whose pharyngotomies were amenable to primary closure. Of this group, 37 patients had active endolaryngeal squamous cell carcinoma (SCC), 2 patients had inactive endolaryngeal SCC, 2 patients had thyroid cancer, and 1 patient had been treated for chronic aspiration. A total of 26 patients (61.9%) had undergone traditional suture closure of the neopharynx (suture group) and 16 patients (38.1%) had undergone closure with a linear stapling device (staple group). Other than the fact that the patients in the staple group were significantly older than those in the suture group (median: 71.0 vs. 56.5 yr, p = 0.002), there were no significant differences between the two groups in terms of comorbidities or cricopharyngeal myotomy, tracheoesophageal puncture, or neck dissection. There was a total of 8 postoperative infections-5 in the staple group (31.3%) and 3 in the suture group (11.5%)-not a statistically significant difference. Fistulas occurred in 4 staple patients (25.0%) and 6 suture patients (23.1%)-again, not statistically significant. We conclude that in appropriately selected patients, primary closure of the neopharynx can be safely and effectively achieved with a linear stapling device.
authors: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029-6574, USA. brett.miles@mountsinai.org
authors: Brett A
authors: BA
authors: Miles
authors: Deborah
authors: D
authors: Larrison
authors: Larry L
authors: LL
authors: Myers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D005402:Fistula / Q000209:etiology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology; D013964:Thyroid Neoplasms / Q000601:surgery*