Effects of perioperative radiation treatment on stricture and fistula formation in hypopharyngeal reconstruction: a meta-analysis

Abstract

Hypopharyngeal reconstruction is a surgically challenging procedure, and postoperative management is important due to a high rate of complications following surgery. In particular, stricture and fistula formation is the most common long-term postoperative complication. Through systematic review and meta-analysis of 21 studies, a significant radiation effect of stricture and fistula formation was found in patients who underwent hypopharyngeal reconstruction. The perioperative radiation must be seen as a critical factor for stricture and fistula formation in hypopharyngeal reconstruction.

Latissimus dorsi myocutaneous free flap for the laryngopharyngectomy defect

“…Of note, four of those patients were still able to safely take PO. Our stricture rate of 29.2% is also similar to prior studies 8,37–41 …”

“…Our stricture rate of 29.2% is also similar to prior studies. 8,[37][38][39][40][41] All patients achieved full shoulder range of motion within 6 months, and they are all able to complete their ADLs before leaving the hospital. It is also important to mention that an additional benefit of the thoracodorsal or subscapular free tissue transfer is cosmesis of the donor site scar, which has been shown to be more appealing to patients compared with scarring from the radial forearm harvest.…”

“…[4][5][6] Prior studies have demonstrated greater risk in those with history of radiation, poor nutrition, hypothyroidism, heart failure, diabetes, anemia, liver disease, and advanced tumor stage. [5][6][7][8][9] A recent meta-analysis of 1357 circumferential defects reported a cumulative pharyngocutaneous fistula incidence of 16.1% (both radiated and nonradiated patients), with a range of 10% (jejunum free flap) to 42% (tubed pectoralis flap). Commonly used flaps for patients that are radiated or will have insufficient remaining pharyngeal mucosa for closure include the pedicled pectoralis major, jejunum free flap, anterolateral thigh free flap, and radial forearm free flap.…”

“…The development of pharyngocutaneous fistula varies depending on patient risk factors and defect size 4–6 . Prior studies have demonstrated greater risk in those with history of radiation, poor nutrition, hypothyroidism, heart failure, diabetes, anemia, liver disease, and advanced tumor stage 5–9 . A recent meta‐analysis of 1357 circumferential defects reported a cumulative pharyngocutaneous fistula incidence of 16.1% (both radiated and non‐radiated patients), with a range of 10% (jejunum free flap) to 42% (tubed pectoralis flap).…”

Reconstructive methods to resolve intractable fistulas that develop after radiation therapy in patients with head and neck cancer

“…Orocutaneous fistula formation is a serious complication of RT that leads to wound infection, dysphasia, dysphagia, rupture of anastomotic vessels, and carotid blowout syndrome, which is defined as the rupture of the extracranial carotid artery or its branches, resulting in high morbidity and mortality [ 4 - 6 ]. Moreover, complications caused by a fistula can reduce a patient’s quality of life and make timely postoperative chemotherapy and radiotherapy administration difficult [ 7 , 8 ].…”