Abstract
A pharyngocutaneous fistula (PCF) is the most common complication after salvage total laryngectomy (STL) with an incidence ranging from 5 to 73%, causing an increase in morbidity and delaying the patient’s recovery. A surgical technique to prevent PCF formation is the use of the stapler to suture the pharyngeal mucosa. We have reviewed the medical files of 91 patients who had undergone STL, dividing the patients into two groups (manual suture vs. stapler), based on the type of pharyngeal suture performed during the STL. We found 12/49 (24.5%) cases of a PCF in group A (manual) and 5/42 (11.9%) cases of a PCF in group B (stapler). There is a statistically significant difference between the two groups with the patients in group B presenting better results in terms of the reduction of the surgical time, the length of the hospital stay and also in the restarting of oral feeding. The advantages of mechanical suturing with the stapler are reduced surgical times, a lower PCF formation rate, which involves an early removal of the nasogastric tube, and reduced hospitalization times. Further studies with a larger case series will be necessary to confirm the results obtained and to standardize the surgical technique.
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References
Galli J, Salvati A, Di Cintio G et al (2021) Stapler use in salvage total laryngectomy: a useful tool? Laryngoscope 131:473–478. https://doi.org/10.1002/lary.28737
Aires FT, Dedivitis RA, Castro MA et al (2014) Efficacy of stapler pharyngeal closure after total laryngectomy: a systematic review. Head Neck 36:739–742. https://doi.org/10.1002/hed.23326
Liang JW, Li ZD, Li SC et al (2015) Pharyngocutaneous fistula after total laryngectomy: a systematic review and meta-analysis of risk factors. Auris Nasus Larynx 42:353–359. https://doi.org/10.1016/j.anl.2015.04.002
Hasan Z, Dwivedi RC, Gunaratne DA et al (2017) Systematic review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg Oncol 43:42–51. https://doi.org/10.1016/j.ejso.2016.05.017
Tsetsos N, Poutoglidis A, Vlachtsis K et al (2021) Twenty-year experience with salvage total laryngectomy: lessons learned. J Laryngol Otol 135:729–736. https://doi.org/10.1017/S0022215121001687
Simoncelli C, Altissimi G (1990) Mechanical sutures of the pharynx during total laryngectomy: proposal of a closed technique. Acta Otorhinolaryngol Ital 10:465–474
Altissimi G, Frenguelli A (2007) Linear stapler closure of the pharynx during total laryngectomy: a 15-year experience (from closed technique to semi-closed technique). Acta Otorhinolaryngol Ital 27:118–122
Edge SB (2017) American Joint Committee on Cancer (AJCC) cancer staging manual, 8th edn. Springer, New York
El-Naggar AK (2017) WHO classification of tumors pathology and genetics of head and neck tumors, 4th edn. IARC Press, Lyon
Dedivitis RA, Aires FT, Cernea CR et al (2015) Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors. Head Neck 37:1691–1697. https://doi.org/10.1002/hed.23804
Kim YH, Roh JL, Choi SH et al (2019) Prediction of pharyngocutaneous fistula and survival after salvage laryngectomy for laryngohypopharyngeal carcinoma. Head Neck 41:3002–3008. https://doi.org/10.1002/hed.25786
Basheeth N, O’Leary G, Sheahan P (2014) Pharyngocutaneous fistula after salvage laryngectomy: impact of interval between radiotherapy and surgery, and performance of bilateral neck dissection. Head Neck 36:580–584. https://doi.org/10.1002/hed.23337
Casasayas M, Sansa A, García-Lorenzo J et al (2019) Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal. Eur Arch Otorhinolaryngol 276:143–151. https://doi.org/10.1007/s00405-018-5200-4
Dedivitis RA, Aires FT, Pfuetzenreiter EG Jr et al (2014) Stapler suture of the pharynx after total laryngectomy. Acta Otorhinolaryngol Ital 34:94–98
Lee YC, Fang TJ, Kuo IC, Tsai YT, Hsin LJ (2021) Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: a systematic review and meta-analysis. Clin Otolaryngol 46:692–698. https://doi.org/10.1111/coa.13702
Bedrin L, Ginsburg G, Horowitz Z et al (2005) 25-year experience of using a linear stapler in laryngectomy. Head Neck 27:1073–1079. https://doi.org/10.1002/hed.20280
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Salzano, G., Maglitto, F., Calvanese, C. et al. Pharyngocutaneous Fistula in Salvage Laryngectomy: Use of the Stapler Versus Manual Suturing Technique. Indian J Otolaryngol Head Neck Surg 75, 1441–1446 (2023). https://doi.org/10.1007/s12070-023-03587-7
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DOI: https://doi.org/10.1007/s12070-023-03587-7