title: Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis.
abstract: Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy.
authors.affiliation: Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK. rwahone@doctors.org.uk.|Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK. rwahone@doctors.org.uk.
authors.forename: Robert W A
authors.initials: RWA
authors.lastname: Hone
authors.affiliation: Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK.
authors.forename: Eqramur
authors.initials: E
authors.lastname: Rahman
authors.affiliation: Ear, Nose and Throat Department, Brighton and Sussex University Hospital, 177 Preston Rd, Brighton, UK.
authors.forename: Gentle
authors.initials: G
authors.lastname: Wong
authors.affiliation: Ear, Nose and Throat Department, Charing Cross Hospital, Fulham Palace Rd, London, UK.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Annan
authors.affiliation: Ear, Nose and Throat Department, Guy's Hospital, Great Maze Pond, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Alexander
authors.affiliation: Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Lami
authors.affiliation: Ear, Nose and Throat Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, UK.
authors.forename: Kiran
authors.initials: K
authors.lastname: Varadharajan
authors.affiliation: Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Parker
authors.affiliation: Ear, Nose and Throat Department, Guy's Hospital, Great Maze Pond, London, UK.
authors.forename: Ricard
authors.initials: R
authors.lastname: Simo
authors.affiliation: Ear, Nose and Throat Department, Royal Surrey County Hospital, Egerton Rd, Guildford, Surrey, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Pitkin
authors.affiliation: Ear, Nose and Throat Department, Charing Cross Hospital, Fulham Palace Rd, London, UK.
authors.forename: Alasdair
authors.initials: A
authors.lastname: Mace
authors.affiliation: Ear, Nose and Throat Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, UK.
authors.forename: Enyinnaya
authors.initials: E
authors.lastname: Ofo
authors.affiliation: Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK.
authors.forename: Alistair
authors.initials: A
authors.lastname: Balfour
authors.affiliation: Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK.
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D059248:Chemoradiotherapy / Q000009:adverse effects; D017577:Cutaneous Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010608:Pharyngeal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D018987:Salivary Ducts / Q000601:surgery*; D006113:United Kingdom / Q000453:epidemiology
keywords: Cancer; Complications; Fistula; Laryngectomy; Salivary bypass tube