Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking

Aslıer, Nesibe Gül Yüksel; Doğan, Ersoy; Aslıer, Mustafa; İkiz, Ahmet Ömer

doi:10.5152/tao.2016.1878

Cited by 14 publications

(17 citation statements)

References 27 publications

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“…In theory, the trifurcation in the T-shaped closure might increase the risk of fistula development, which is supported by the findings of some studies [66,67]. However, in contrast, other studies have suggested that a fistula occurs more frequently with vertical closure [63,68,69]. It is assumed that the T-shaped closure causes less tension than the vertical closure in some defect shapes.…”

Section: The Mucosal Layermentioning

confidence: 79%

Total Laryngectomy: A Review of Surgical Techniques

Chotipanich

2021

Cureus

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Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this procedure. The surgical techniques employed in total laryngectomy have not been comprehensively discussed to date. Thus, the main objective of this article was to address controversial aspects related to this procedure and compare different surgical techniques used for a total laryngectomy procedure from the beginning to the end.Although the management paradigms in laryngeal and hypopharyngeal squamous cell carcinomas have shifted to organ-preserving chemoradiotherapy protocols, total laryngectomy still plays a prominent role in the treatment of advanced and recurrent tumors. The increased incidence of complications associated with salvage total laryngectomy has driven efforts to improve the surgical techniques in various aspects of the operation. Loss of voice and impaired swallowing are the most difficult challenges to be overcome in laryngectomies, and the introduction of tracheoesophageal voice prostheses has made an enormous difference in postoperative rehabilitation and quality of life. Advancements in reconstruction techniques, tumor control, and metastatic management, such as prophylactic neck treatments and paratracheal nodal dissection (PTND), as well as the use of thyroid gland-preserving total laryngectomy in selected patients have all led to the increasing success of modern total laryngectomy. Several conclusions regarding the benchmarking of surgical techniques cannot be drawn. Issues regarding total laryngectomy are still open for discussion, and the technique will continue to require improvement in the near future.

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Section: The Mucosal Layermentioning

confidence: 79%

Total Laryngectomy: A Review of Surgical Techniques

Chotipanich

2021

Cureus

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“…Although the benefit of flap augmentations is that they have proven to lower fistula rates, most fistulas close by secondary intention without perpetuating long-term morbidity. 11,27 For this reason, primary closure results in better quality of life for as long as patients remain disease free.…”

Section: Discussionmentioning

confidence: 99%

“…Our analysis concludes that in most cases, primary closure after salvage TL is the most cost‐effective method when considering all factors. Although the benefit of flap augmentations is that they have proven to lower fistula rates, most fistulas close by secondary intention without perpetuating long‐term morbidity 11 , 27 . For this reason, primary closure results in better quality of life for as long as patients remain disease free.…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction After Salvage Total Laryngectomy: A Cost‐effectiveness Analysis

Acevedo

Cameron

et al. 2020

Otolaryngol.--head neck surg.

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Objective To determine the most cost-effective reconstruction method after salvage total laryngectomy. Study Design Cost-effectiveness analysis Setting Tertiary care hospitals with head and neck oncologic and reconstructive surgeons. Subjects and Methods We constructed a Markov-based decision model to compare reconstruction by primary closure to pectoralis flap and free flap after salvage total laryngectomy. The model simulated disease with transition probabilities and health utilities found in primary literature and estimated the average overall cost of each reconstructive method using Medicare billing codes. Effectiveness was compared using quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were performed to scrutinize the conclusions of our model. Reconstruction methods were compared using incremental cost-effectiveness ratios (ICERs). In the United States, less than $150,000 per QALY gained is considered cost-effective (2019 US dollars). Results Our base case analysis revealed that primary closure was less expensive ($44,370) and yielded more QALYs (0.91) than both pectoralis ($45,163, 0.81 QALYs) and free flap ($46,244, 0.85 QALYs), making it the most cost-effective option. Between flaps, free flap was cost-effective over pectoralis flap (ICER = $27,025/QALY gained). Sensitivity analyses showed primary closure as cost-effective 69% of the time over either flap. These conclusions were sensitive to the health utilities (quality of life) of each method of reconstruction. Conclusion Tissue flaps to augment closure after salvage total laryngectomy are not always the most cost-effective reconstructive option. The long-term morbidity of flap surgery oftentimes outweighs the benefit of lowering fistula rates after surgery. Careful consideration must be taken when advising patients of their reconstructive options.

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“…Several studies have specifically examined the impact of smoking status on outcomes following total laryngectomy, but these analyses have been limited to small, single‐institution cohorts . The National Surgical Quality Improvement Program (NSQIP) is an American College of Surgeons sponsored database that allows for the study of demographics, comorbidities, and 30‐day postoperative complications of surgical patients.…”

Section: Introductionmentioning

confidence: 99%