Pharyngo-cutaneous fistula complicating laryngectomy in the chemo-radiotherapy organ-preservation epoch.
Pharyngo-cutaneous fistula is a serious complication of laryngectomy, with a significant associated morbidity and mortality. The oncologic success of organ-preservation protocols with radiotherapy or chemo-radiotherapy for laryngeal carcinoma means laryngectomy is increasingly reserved for surgical salvage in the event of persistent or recurrent disease. A retrospective review of fistula incidence after laryngectomy in 171 patients in a UK tertiary referral centre over the last decade was conducted to identify trends in this complication in the epoch of non-surgical organ preservation. The overall fistula incidence following laryngectomy is 29.2% (50/171). Fistula incidence following salvage total laryngectomy is significantly higher than after primary total laryngectomy [19/51 (37.3%) vs. 8/47 (17.0%), χ2 = 5.02, p = 0.03]. There is no significant effect of prior treatment on fistula incidence following laryngo-pharyngectomy or pharyngo-laryngo-oesophagectomy [14/39 (35.9%) vs. 9/27 (33.3%), χ2 = 0.05, p = 0.83]. Prophylactic vascularised tissue flaps to reinforce the pharyngeal suture line may reduce fistula incidence and fistula severity in salvage total laryngectomy.
Mark
M
Sayles
Stephanie L
SL
Koonce
Laura
L
Harrison
Nigel
N
Beasley
Andrew R
AR
McRae
David G
DG
Grant
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery* / Q000628:therapy; D059248:Chemoradiotherapy; D015331:Cohort Studies; D017577:Cutaneous Fistula / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery* / Q000628:therapy; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D013524:Surgical Flaps; D017211:Treatment Failure