Radiotherapy and complications of laryngectomy

Abstract

In an effort to establish factors responsible for our post laryngectomy fistulae we reviewed 357 patients who underwent total laryngectomy between 1965 and 1990, for laryngeal carcinoma. Pharyngocutaneous fistulae occurred in 84 cases (23 percent). There was no difference between the fistula group and the non-fistula group with regard to age, sex, general condition, or tumour differentiation. The only significant, positive association was with previous radical radiotherapy (10 fistulae out of 167 primary laryngectomies (4 percent) versus 74 fistulae out of 190 salvage laryngectomies (39 percent)). The median time to occurrence of a fistula was day seven in both groups. However, in the non-radiotherapy group the median duration of the fistula was 28 days; the majority healing spontaneously, with only one patient requiring surgical closure. There were no ‘hospital’ deaths. In the radiotherapy group the median duration of fistulae was 112 days with 30 patients requiring a total of 66 procedures to achieve closure of the fistula. There were six ‘hospital’ deaths in this group.We conclude that previous radical radiotherapy strongly predisposes towards the occurrence of a postlaryngectomy fistula. Fistulae in this group tend to be longer lasting and are more likely to require surgical repair.

Post-operative pharyngocutaneous fistula after laryngectomy

“…Some retrospective studies have reported an increased incidence of wound and systemic complications for salvage laryngectomy after RT or CRT (9,10,11,12).…”

Pharyngoesophageal reconstruction with the anterolateral thigh flap after total laryngopharyngectomy

“…In such cases, primary closure of the pharynx may not be possible or may carry a high risk for pharyngocutaneous fistulas, [4][5][6][7][8] and primary reconstruction of these pharyngoesophageal defects is often required. The goals of reconstruction are to provide alimentary tract continuity and to restore speech and swallowing functions.…”

Prevention of wound complications following salvage laryngectomy using free vascularized tissue

“…Free vascularized tissue reinforcement of primary pharyngeal closure in salvage laryngectomy following failed organ preservation is effective in preventing major wound complications but did not reduce the overall fistula rate. Fistulas that developed following this technique were relatively small, did not result in exposed major vessels, and were effectively treated with outpatient wound care rather than readmission to the hospi- 5 for fistula development have been identified in various retrospective studies. With the advent of organ preservation therapy for advanced head and neck cancer, the use of combined chemotherapy and radiation therapy has become increasingly frequent.…”