The Utility of Barium Swallow Studies for Evaluation of Pharyngocutaneous Fistula After Total Laryngectomy

Amin, Julian; Ortlip, Timothy; Cohen, Deanna; Vakharia, Kalpesh T.; Lubek, Joshua E.

doi:10.24983/scitemed.aohns.2020.00133

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Those patients with radiographic findings suggestive of an anastomotic leak, but without clinical evidence of PCF, were included in the non-PCF group because radiographic leaks have been demonstrated to have low positive predictive value 14 -a number of patients deemed to have leaks on radiographic studies have had false positive results. Leak studies are often ordered based on clinician preference prior to oral feeding.…”

Section: Methodsmentioning

confidence: 99%

Association of Pharyngocutaneous Fistula With Cancer Outcomes in Patients After Laryngectomy

Davies

Hugh

Rich

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Pharyngocutaneous fistula (PCF) results in an inflammatory reaction, but its association with the rate of locoregional and distant control, disease-free survival, and overall survival in laryngeal cancer remains uncertain.OBJECTIVE To determine if pharyngocutaneous fistula after salvage laryngectomy is associated with locoregional and distant control, disease-free survival, and/or overall survival. DESIGN, SETTING, AND PARTICIPANTSA multicenter collaborative retrospective cohort study conducted at 5 centers in Canada and the US of 550 patients who underwent salvage laryngectomy for recurrent laryngeal cancer from January 1, 2000, to December 31, 2014. The median follow-up time was 5.7 years (range, 0-18 years). MAIN OUTCOMES AND MEASURESOutcomes examined included locoregional and distant control, disease-free survival, and overall survival. Fine and Gray competing risk regression and Cox-proportional hazard regression models were used for outcomes. Competing risks and the Kaplan-Meier methods were used to estimate outcomes at 3 years and 5 years. RESULTSIn all, 550 patients (mean [SD] age, 64 [10.4] years; men, 465 [85%]) met inclusion criteria. Pharyngocutaneous fistula occurred in 127 patients (23%). The difference in locoregional control between the group of patients with PCF (75%) and the non-PCF (72%) group was 3% (95% CI, −6% to 12%). The difference in overall survival between the group with PCF (44%) and the non-PCF group (52%) was 8% (95% CI, −2% to 20%). The difference in disease-free survival between PCF and non-PCF groups was 6% (95% CI, −4% to 16%). In the multivariable model, patients with PCF were at a 2-fold higher rate of distant metastases (hazard ratio, 2.00; 95% CI, 1.22 to 3.27). Distant control was reduced in those with PCF, a 13% (95% CI, 3% to 21%) difference in 5-year distant control.CONCLUSIONS AND RELEVANCE This multicenter retrospective cohort study found that development of PCF after salvage laryngectomy is associated with an increased risk for the development of distant metastases.

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Section: Methodsmentioning

confidence: 99%

Association of Pharyngocutaneous Fistula With Cancer Outcomes in Patients After Laryngectomy

Davies

Hugh

Rich

et al. 2021

JAMA Otolaryngol Head Neck Surg

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“…The potential for a stricture and/or oesophageal dysfunction to be present should be considered in all patients following total laryngectomy. swallow to dictate commencement of oral intake [16].…”

Section: Key Pointsmentioning

confidence: 99%

“…It is standard practice to conduct a fluoroscopic contrast swallow to determine whether a postoperative leak is present prior to commencing oral intake. A recent retrospective review of contrast swallows to determine leakage, conducted 1–3 weeks post operatively, demonstrated 50% sensitivity and 92.1% specificity, with a positive predictive value of 62.5% and a negative predictive value of 87.5% [16]. A randomized controlled trial is needed to determine best practice regarding timing and protocols to commence oral intake.…”

Section: Objective Assessment Of Swallow Dysfunction Following Total ...mentioning

confidence: 99%

“…A randomized controlled trial is needed to determine best practice regarding timing and protocols to commence oral intake. These findings suggest ‘high risk’ patients, (salvage laryngectomy following preoperative radiotherapy and/or those who required a free flap reconstruction), should remain nonoral for an extended period, rather than relying on results from the contrast swallow to dictate commencement of oral intake [16].…”

Section: Objective Assessment Of Swallow Dysfunction Following Total ...mentioning

confidence: 99%

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Swallowing after total laryngectomy surgery: where are we after 150 years?

O’Connor,

Maclean

2024

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Recent findings Dysphagia is a common sequela following total laryngectomy surgery; however, there is significant variability in its assessment and management. Manometry enables an accurate understanding of the underlying mechanism of dysphagia and precise assessment of any oesophageal dysfunction. EndoFLIP is a useful tool to better understand dysfunction of the upper oesophageal sphincter particularly to detect stricture. Summary Following total laryngectomy surgery, dysphagia is common; clinicians need to be alert to early indicators of dysfunction and understand the tools to comprehensively characterize swallow function. Accurate diagnosis of a stricture is important, as this aspect of dysfunction can be modified, and may alleviate surrogate problems such as a leaking voice prosthesis. Clinicians should have a low threshold to examine patients for oesophageal dysfunction due to the high prevalence of dysmotility following a laryngectomy.

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“…The reported incidence of perioperative mortality for patients with head and neck cancer undergoing TORS ranges from 0.07-3.3% (Table 1) (2,7,14,(16)(17)(18)(19). Although these studies provide a general estimate, no study has specifically examined perioperative mortality as a primary outcome of TORS using national or hospital-based data.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Mortality Risk in Patients Undergoing Transoral Robotic Surgery for T1-T2 Oropharyngeal Squamous Cell Carcinoma: A National Cancer Database Study

et al. 2022

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The National Cancer Database is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methods used or for the conclusions drawn from these data by the investigators.IntroductionTransoral robotic surgery (TORS) is well established as initial definitive treatment for early-stage oropharyngeal squamous cell carcinoma (OPSCC) as an alternative to radiation therapy with similar survival rates. While proponents of TORS focus on the reduced morbidity of treatment compared to open procedures, shortened hospital admissions and equivalent survival outcomes to non-surgical treatment, there remain concerns over the risk of mortality within the acute perioperative period. Therefore, we sought to determine the 30-day and 90-day perioperative mortality risk using the National Cancer Database.MethodsA retrospective cohort analysis was performed for patients diagnosed with pathologic T1/2 OPSCC between January 1, 2010, and December 31, 2016 that underwent primary surgical treatment with TORS and was not restricted by HPV status. The primary outcome was 30-day perioperative mortality. The secondary outcome was 90-day perioperative mortality. Univariable analysis was used to identify variables associated with 30-day perioperative mortality.ResultsIn total, 4,127 patients (mean [SD; range] age, 59 [9.5; 22-90] years; 3,476 [84%] men and 651 [16%] women) met inclusion criteria. The number of patients with pT1-2 OPSCC undergoing TORS increased three-fold between 2010 (279/4,127; 7%) to 2016 (852/4,127; 21%). The overall 30-day and 90-day perioperative mortality rate for TORS during the study period was 0.6% (23/4,127) and 0.9% (38/4,127), respectively. On univariable analysis (UVA), age≥65 was the only predictor of 30-day perioperative mortality (OR 3.41; 95% CI 1.49-7.81).ConclusionThe overall risk of all cause mortality following TORS for early-stage OPSCC remains low. The risk of mortality is higher in elderly patients and should be considered, in addition to previously established risk factors, during patient selection and counselling.

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The Utility of Barium Swallow Studies for Evaluation of Pharyngocutaneous Fistula After Total Laryngectomy

Cited by 5 publications

References 16 publications

Association of Pharyngocutaneous Fistula With Cancer Outcomes in Patients After Laryngectomy

Association of Pharyngocutaneous Fistula With Cancer Outcomes in Patients After Laryngectomy

Swallowing after total laryngectomy surgery: where are we after 150 years?

Perioperative Mortality Risk in Patients Undergoing Transoral Robotic Surgery for T1-T2 Oropharyngeal Squamous Cell Carcinoma: A National Cancer Database Study

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