Systematic review and meta-analysis of the complications of salvage total laryngectomy.
OBJECTIVE
Management paradigms in laryngeal cancer have shifted to "organ preservation" chemoradiotherapy protocols. In the event of treatment failure, salvage total laryngectomy remains the only curative treatment option. However a comprehensive review of the complications of this procedure has not been reported.


METHODS
A systematic review of the literature was performed using keywords "salvage laryngectomy" to retrieve relevant publications between January 2000 and August 2015.


RESULTS
Of the 407 articles retrieved from the literature search, 50 studies encompassing 3292 patients were included. Forty-nine studies reported pharyngocutaneous fistula which occurred in 859 patients (pooled incidence 28.9%; 95% confidence intervals 25.5-32.5%). Twenty-four studies reported complications in addition to PCF and these included wound complications (infection, dehiscence and necrosis), dysphagia, bleeding, and pharyngeal and stomal stenosis.


CONCLUSIONS
Overall complication rate was 67.5%, Pharyngocutaneous fistula was the commonest complication with a pooled incidence of 28.9%.
Department of Otolaryngology-Head & Neck Surgery, Westmead Hospital, Cnr Darcy & Hawkesbury Road, Westmead, NSW, 2145, Australia. Electronic address: zubairhasan_112@hotmail.com.
Z
Z
Hasan
Addenbrooke's Hospital, Cambridge University Teaching Hospital NHS Trust, Royal Marsden Hospital, London, UK.
R C
RC
Dwivedi
Department of Otolaryngology-Head & Neck Surgery, Westmead Hospital, Cnr Darcy & Hawkesbury Road, Westmead, NSW, 2145, Australia.
D A
DA
Gunaratne
University of New South Wales, Randwick, NSW, 2052, Australia.
S A
SA
Virk
Department of Otolaryngology-Head & Neck Surgery, Westmead Hospital, Cnr Darcy & Hawkesbury Road, Westmead, NSW, 2145, Australia.
C E
CE
Palme
Department of Otolaryngology-Head & Neck Surgery, Westmead Hospital, Cnr Darcy & Hawkesbury Road, Westmead, NSW, 2145, Australia.
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F
Riffat
D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D011183:Postoperative Complications; D016879:Salvage Therapy / Q000379:methods*
Complications; Head & neck surgery; Laryngeal cancer; Laryngectomy; Pharyngocutaneous fistula; Salvage surgery