The Role of Pectoralis Major Muscle Flap in Salvage Total Laryngectomy

Gil, Ziv; Gupta, Amar; Kummer, Ben; Cordeiro, Peter G.; Kraus, Dennis H.; Shah, Jatin P.; Patel, Snehal G.

doi:10.1001/archoto.2009.126

Cited by 91 publications

(129 citation statements)

References 26 publications

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“…In other studies [18,[25][26][27][28] mean time of restoration a normal feeding was 25 days and in Pellini's study was in less than 1 month for 61.5 % of patients [22]. The time of removal of the feeding tube ranged in literature from 10-96 days [28] to 12-90 days [18], in our study was 4-230 days. Only one patient (5 %) was not able to restore normal swallowing functions and required percutaneous endoscopic gastrostomy, similar results to Makeieff's (4.4 %) and Pellini's (7.7 %) studies.…”

Section: Complications and Functional Resultssupporting

confidence: 40%

Surgical options in radiotherapy-failed early glottic cancer

Santoro

Meccariello

Mannelli

et al. 2013

Eur Arch Otorhinolaryngol

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After failure of curative radiotherapy (RT), surgery is the main therapeutic option to control recurrent laryngeal cancer. Recurrences after RT for T1-T2 tumours of the glottic larynx are often diagnosed at a more severe stage than the original disease and, thus, usually treated by radical approaches. Our aim is to investigate the feasibility of more conservative strategies for proper treatment of post-RT recurred glottic cancer. We collected and reviewed our files from 1990 to 2006, selecting 75 patients which matched the following inclusion criteria: (1) patient was originally diagnosed with early stage squamous cell carcinoma of the glottic larynx (stage I-II according to 2010 TNM), (2) patient was treated by RT with curative intent, (3) patient presented a recurrence of disease after RT which was surgically treated at our Institution. T stage at first diagnosis was T1a in 41 cases (55 %), T1b in 12 (16 %) and T2 in 22 (29 %). At clinical examination of RT-recurred lesions, we documented advanced lesions (rT3-rT4) in 29 out of 75 patients (39 %). Overall, an upstage was reported for 56 % RT-recurred cancers, while 37.3 % remained at the same stage than the original tumour and 6.7 % were downstaged. Twelve patients (16 %) underwent salvage partial laryngectomy (SPL), while 63 (84 %) received a salvage total laryngectomy (STL). Multivariate analysis showed that rTNM according to the AJCC-UICC of 2010 was the only prognostic factor for both disease-free survival (p = 0.042) and overall survival (p = 0.004). Considering the prognostic impact of rT and rN we documented a statistical significance only in terms of overall survival for both factors (p = 0.004 and p = 0.04, respectively). Although STL remains the most frequent treatment choice for failures after RT in laryngeal carcinomas, SPL represents a valid option for selected patients with limited recurrence and can deliver good oncologic and functional results if performed according to careful indications.

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Section: Complications and Functional Resultssupporting

confidence: 40%

Surgical options in radiotherapy-failed early glottic cancer

Santoro

Meccariello

Mannelli

et al. 2013

Eur Arch Otorhinolaryngol

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“…In past a variety of factors has been implicated for the increased fistula rate, which can be divided as, patient, disease and treatment related factors [7][8][9]. The proposed predictive variables associated with pharyngocutaneous fistula development related to the patient are, gender, alcohol, smoking habits, American Society of Anaesthesiologists risk classification system (ASA scale), Haemoglobin and serum albumin level, and associated comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Among the tumor related factors studied are stage, location, grade and margin status. Few treatment related factors as previous radiation exposure and surgical technical aspects also implicated [9].…”

Section: Introductionmentioning

confidence: 99%

Pharyngocutaneous Fistula Incidence After PMMC Patch Pharnygoplasty for Post Laryngectomy Defect Reconstruction – Predictive Factors, Our Experience at KMIO

Lakhera

Shenoy

Chavan

et al. 2015

Indian J Surg Oncol

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To analyse pharyngocutaneous fistula, post Pectoralis major myocutaneous patch pharnygoplasty, and its association with various tumor, patient and treatment related factors. It is a retrospective study that included 48 patients who underwent laryngectomy and PMMC patch pharyngeal reconstruction from year 2009 to 2013. We studied the previously reported factors that could influence fistula formation such as age, gender, previous radiotherapy, previous tracheostomy, location of tumor, extent of tumor, tumor volume, tumor stage and surgical margins. Pharyngocutaneous fistula was observed in 13(27.1 %) cases. In 84.6 % (n=11) patients, fistula closure was achieved by conservative measures. No statistically significant association was found between tumor location, extent and size. There was no association between history of previous tracheostomy and postoperative microscopic margin status. Patients with T4 disease showed increased association (36.7 %) compare to T3 stage (11 %) (p value-0.0362). Postoperatively 6 patients presented with dysphagia out of which 4 patients (66.7 %) had history of leak. It also showed significant increase in post operative stay and delay in oral feeding in fistula patients. There is still no consensus regarding the most significant risk factors, our data showed that, most disease and treatment related parameters were not predictive for fistula occurence. Prabably a larger number of patient cohart need to be analysed for additional information.

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“…As it is a regional flap, it does not require specific materials or teams specialized in microsurgical anastomoses; and it introduces low donor site morbidity 2,21 . Myocutaneous flaps could also reduce the risk of late complications such as stenosis, dysphagia, and use of feeding tubes as shown by Patel & Keni 8 ; these findings were not observed in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The development of organ preservation protocols and primary chemoradiotherapy (CRT) for a subgroup of patients with advanced laryngeal cancer resulted in organ preservation rates of 64% and global survival similar to the levels seen in patients offered laryngectomy followed by radiotherapy, a treatment then considered the standard for this type of cancer [2][3][4] . Despite the efficacy of chemoradiotherapy, a considerable number of patients still require salvage surgery -usually in the form of total laryngectomy -when the disease persists or recurs 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Laringectomia de resgate: utilização do retalho miocutâneo de peitoral maior na prevenção de fístula faringocutânea

Sousa¹,

Castro²,

Porcaro-Salles³

et al. 2012

Braz. j. otorhinolaryngol.

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Salvage laryngectomy in patients treated with organ preservation protocols is associated with high rates of postoperative complications. The use of non-irradiated tissue flaps in pharyngeal reconstruction could reduce the incidence of these complications. Objective : This study aims to evaluate the usefulness of the pectoralis major myocutaneous flap in preventing salivary fistulae during the postoperative period of salvage total laryngectomy (TL). Materials and Method : This retrospective study enrolled 31 patients operated between April of 2006 and May of 2011. All patients had advanced cancer at the time of the salvage procedure and had been treated with chemoradiotherapy or radiotherapy alone. Pharyngeal reconstruction was performed using pectoralis major myocutaneous flap in 19 cases (61%); primary wound closure occurred in 12 patients (39%). Results : Salivary fistulae occurred in 16% of the patients who received the flap and in 58% of the patients with primary closure of the pharynx ( p < 0.02). No statistically significant differences were noted between the groups with respect to the mean time for fistula formation, reintroduction of an oral diet, or use of a nasoenteric tube for feeding. Conclusion : The pectoralis major myocutaneous flap was found to reduce the incidence of salivary fistulae in salvage laryngectomy procedures.

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The Role of Pectoralis Major Muscle Flap in Salvage Total Laryngectomy

Abstract: The PMMF should be used judiciously as a surgical adjunct in high-risk patients, with the goal of minimizing the risk for the development of a pharyngocutaneous fistula.

Cited by 91 publications

References 26 publications

Surgical options in radiotherapy-failed early glottic cancer

Surgical options in radiotherapy-failed early glottic cancer

Pharyngocutaneous Fistula Incidence After PMMC Patch Pharnygoplasty for Post Laryngectomy Defect Reconstruction – Predictive Factors, Our Experience at KMIO

Laringectomia de resgate: utilização do retalho miocutâneo de peitoral maior na prevenção de fístula faringocutânea

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