Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: A national survey from DAHANCA

Grau, Cai; Johansen, Lars Vendelbo; Hansen, Hanne Sand; Andersen, Elo; Godballe, Christian; Andersen, Lisbeth Juhler; Hald, Jacob; Møller, Henrik; Overgaard, Marie; Bastholt, Lars; Greisen, O; Harbo, Grethe; Hansen, Olfred; Overgaard, Jens

doi:10.1002/hed.10237

Cited by 92 publications

(91 citation statements)

References 15 publications

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“…In our study, we demonstrated an increased incidence of PCF in patients with preoperative RT, which is in agreement with the majority of literature reports (13)(14)(15)(16)(17)(18)(19)(20). While, some studies did not find any association between preoperative RT and PCF formation (5-7, 21, 22).…”

Section: Discussionsupporting

confidence: 92%

“…While, some studies did not find any association between preoperative RT and PCF formation (5-7, 21, 22). Grau et al (16) found an increased incidence of PCF in patients with preoperative RT in subgroups where patients had advanced initial T stage and non-glottic primary site laryngeal cancer. In another study, the risk of PCF in patients with preoperative RT was found to be related to the characteristics and site of the primary tumor (23).…”

Section: Discussionmentioning

confidence: 99%

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

Aslıer¹,

Doğan²,

Aslıer³

et al. 2016

Turk Arch Otorhinolaryngol

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Objective: In this retrospective cohort study, we aimed to determine the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) and to define the possible predictors for PCF formation. Methods:The medical records of 198 patients with laryngeal squamous cell carcinoma who underwent TL were reviewed. After the exclusion of patients with history of free flap reconstruction, previous laryngeal surgery, and previous radiotherapy (RT) for other primary cancers, the risk factors for PCF were analyzed in 183 patients who were included in the study. Results:The overall incidence of PCF was 20.2%. A history of heavy smoking and previous RT were detected as independent risk factors in both univariate (p=0.004 and p=0.007, respectively) and multivariate (p=0.005) analyses. Preoperative tracheotomy (PT) longer than 14 days was a risk factor for PCF among patients with PT in the univariate analysis (p=0.031). Overall three-and five-year survival rates were statistically indifferent between the PCF and non-PCF groups (p>0.05). However, the overall five-year survival rate was lesser in the persistent PCF group (47%) than in the non-persistent PCF group (83%) (p=0.038). Conclusion:Heavy smoking and previous RT are independent risk factors for PCF, and the persistence of PCF decreases survival rates. Preventable measures should be taken to decrease the incidence and persistence of this complication of TL in the management of patients with possible risk factors.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

Aslıer¹,

Doğan²,

Aslıer³

et al. 2016

Turk Arch Otorhinolaryngol

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“…Others did not Wnd a correlation between previous therapy and PCF formation [5,6,12]. The reported predisposing factors were presence of systemic disease [6,9,11], low postoperative hemoglobin levels [6,11], higher T stage and non-glottic tumor site [13], previous tracheostomy and simultaneous neck dissection [11], pharyngeal extension [6,8,12], and positive margins [5]. We observed a higher Wstula rate to be associated with a higher N classiWcation after adjustment in accordance with the meta-analysis of PCF risk factors [11].…”

Section: Discussionmentioning

confidence: 99%

Complications of total laryngectomy in the era of chemoradiation

Klozar

Čada

Koslabova

2011

Eur Arch Otorhinolaryngol

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As more total laryngectomies (TLE) are nowadays performed as salvage procedures, the rate of postoperative complications increases. The primary aim was to report the rates of postoperative local complications for total laryngectomy in patients with previous radiotherapy or chemoradiotherapy (RT/CRT) in comparison with primary TLE data. We attempted to identify patient-and tumor-related factors predictive of postoperative pharyngocutaneous Wstula (PCF) formation. The secondary aims were to analyze the survival rate in relation to postoperative complications and to study prognostic factors of survival in TLE patients. A retrospective study was conducted in 208 patients. Logistic regression was used to determine the most signiWcant risk factors for Wstula formation. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox multivariate regression. PCF developed in 20.7% of cases. In the group of patients with previous RT/CRT, the Wstula rate was signiWcantly higher (34%). In multivariate analysis, signiWcant risk factors for Wstula formation were previous radiotherapy or chemoradiotherapy (p = 0.02), higher N classiWcation (p = 0.03), and procedure performed by a less experienced surgeon (p = 0.003). The survival and recurrence rates were not inXuenced by PCF formation. The overall survival rates were lower in patients with previous RT/CRT and in patients with lymph node involvement.

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“…Early studies [11,13] did not show a significantly increased fistula rate in patients who have had preoperative radiotherapy, but subsequent studies seem to refute this [10,12,[14][15][16]. A fistula begins as a major accumulating salivary leak from the pharyngeal closure into the subcutaneous space beneath the skin flaps and may be encouraged by a tight distal hypopharyngeal closure.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study Between Double Layered Repair of Pharyngeal Mucosa Against Routine Single Layered Repair in Cases of “Total Laryngectomy with Partial Pharyngectomy” in Respect To Formation of Pharyngo-cutaneous Fistula

Shukla

Dudeja

2014

Indian J Otolaryngol Head Neck Surg

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Advanced glottic cancer (T3,N? & T4) is usually treated in the majority of centres by total laryngectomy. Carcinoma of the larynx is one of the very few subsets of all cancers which have shown a decrease in the 5 year survival rate and this phenomenon has been attributed to a Pharyngocutaneous fistula is the most common complication after total laryngectomy. Comparative study between double layered repair of pharyngeal mucosa against routine single layered repair in cases of ''total laryngectomy with partial pharyngectomy''. All patients with the principal procedure of ''total laryngectomy with partial pharyngectomy'' in department of otorhinolaryngology and head-neck surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India were included in this study. Out of the 20 patients who had undergone total laryngectomy irrespective of the type of mucosal repair, 5 (25 %) patients developed pharyngocutaneous fistula. Out of the 8 patients, with double layered mucosa repair, 1 (12.5 %) patient developed pharyngocutaneous fistula. Out of the 12 patients, with single layered mucosa repair, 4 (33 %) patients developed pharyngocutaneous fistula. Double layered repair of pharyngeal mucosa is associated with a lower incidence of pharyngocutaneous fistula formation and no increased incidence of dysphagia after complete radiotherapy as compared to single layered repair.

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Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: A national survey from DAHANCA

Cited by 92 publications

References 15 publications

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

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

Complications of total laryngectomy in the era of chemoradiation

Comparative Study Between Double Layered Repair of Pharyngeal Mucosa Against Routine Single Layered Repair in Cases of “Total Laryngectomy with Partial Pharyngectomy” in Respect To Formation of Pharyngo-cutaneous Fistula

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