Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle upon Tyne, Nottingham, U.K.
Vinidh
V
Paleri
Mike
M
Drinnan
Michiel W M
MW
van den Brekel
Michael L
ML
Hinni
Patrick J
PJ
Bradley
Gregory T
GT
Wolf
Remco
R
de Bree
Johannes J
JJ
Fagan
Marc
M
Hamoir
Primož
P
Strojan
Juan P
JP
Rodrigo
Kerry D
KD
Olsen
Phillip K
PK
Pellitteri
Ashok R
AR
Shaha
Eric M
EM
Genden
Carl E
CE
Silver
Carlos
C
Suárez
Robert P
RP
Takes
Alessandra
A
Rinaldo
Alfio
A
Ferlito
D017577:Cutaneous Fistula / Q000209:etiology / Q000517:prevention & control*; D005402:Fistula / Q000517:prevention & control*; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D010608:Pharyngeal Diseases / Q000209:etiology / Q000517:prevention & control*; D016879:Salvage Therapy / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*
Salvage laryngectomy; free flaps; pedicled flaps; pharyngocutaneous fistula; reconstruction; recurrent laryngeal cancer