Salvage total laryngectomy: is a flap necessary?

Detalhes bibliográficos
Autor(a) principal: Gonzalez-Orús Álvarez-Morujo,Ricardo
Data de Publicação: 2020
Outros Autores: Martinez Pascual,Paula, Tucciarone,Manuel, Fernández Fernández,Mario, Souviron Encabo,Rosalia, Martinez Guirado,Tomás
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Brazilian Journal of Otorhinolaryngology
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942020000200228
Resumo: Abstract Introduction: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. Objective: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. Methods: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. Results: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p = 0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p = 0.03) and large pharyngostomes (64.3% versus 0%, p = 0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p = 0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p = 0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. Conclusions: Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.
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spelling Salvage total laryngectomy: is a flap necessary?Salvage total laryngectomyPectoralis major flapPharyngocutaneous fistulaRadiotherapyAbstract Introduction: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. Objective: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. Methods: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. Results: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p = 0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p = 0.03) and large pharyngostomes (64.3% versus 0%, p = 0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p = 0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p = 0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. Conclusions: Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.2020-04-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942020000200228Brazilian Journal of Otorhinolaryngology v.86 n.2 2020reponame:Brazilian Journal of Otorhinolaryngologyinstname:Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF)instacron:ABORL-CCF10.1016/j.bjorl.2018.11.007info:eu-repo/semantics/openAccessGonzalez-Orús Álvarez-Morujo,RicardoMartinez Pascual,PaulaTucciarone,ManuelFernández Fernández,MarioSouviron Encabo,RosaliaMartinez Guirado,Tomáseng2020-05-15T00:00:00Zoai:scielo:S1808-86942020000200228Revistahttp://www.bjorl.org.br/https://old.scielo.br/oai/scielo-oai.phprevista@aborlccf.org.br||revista@aborlccf.org.br1808-86861808-8686opendoar:2020-05-15T00:00Brazilian Journal of Otorhinolaryngology - Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF)false
dc.title.none.fl_str_mv Salvage total laryngectomy: is a flap necessary?
title Salvage total laryngectomy: is a flap necessary?
spellingShingle Salvage total laryngectomy: is a flap necessary?
Gonzalez-Orús Álvarez-Morujo,Ricardo
Salvage total laryngectomy
Pectoralis major flap
Pharyngocutaneous fistula
Radiotherapy
title_short Salvage total laryngectomy: is a flap necessary?
title_full Salvage total laryngectomy: is a flap necessary?
title_fullStr Salvage total laryngectomy: is a flap necessary?
title_full_unstemmed Salvage total laryngectomy: is a flap necessary?
title_sort Salvage total laryngectomy: is a flap necessary?
author Gonzalez-Orús Álvarez-Morujo,Ricardo
author_facet Gonzalez-Orús Álvarez-Morujo,Ricardo
Martinez Pascual,Paula
Tucciarone,Manuel
Fernández Fernández,Mario
Souviron Encabo,Rosalia
Martinez Guirado,Tomás
author_role author
author2 Martinez Pascual,Paula
Tucciarone,Manuel
Fernández Fernández,Mario
Souviron Encabo,Rosalia
Martinez Guirado,Tomás
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Gonzalez-Orús Álvarez-Morujo,Ricardo
Martinez Pascual,Paula
Tucciarone,Manuel
Fernández Fernández,Mario
Souviron Encabo,Rosalia
Martinez Guirado,Tomás
dc.subject.por.fl_str_mv Salvage total laryngectomy
Pectoralis major flap
Pharyngocutaneous fistula
Radiotherapy
topic Salvage total laryngectomy
Pectoralis major flap
Pharyngocutaneous fistula
Radiotherapy
description Abstract Introduction: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. Objective: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. Methods: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. Results: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p = 0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p = 0.03) and large pharyngostomes (64.3% versus 0%, p = 0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p = 0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p = 0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. Conclusions: Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.
publishDate 2020
dc.date.none.fl_str_mv 2020-04-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942020000200228
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dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1016/j.bjorl.2018.11.007
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.
publisher.none.fl_str_mv Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.
dc.source.none.fl_str_mv Brazilian Journal of Otorhinolaryngology v.86 n.2 2020
reponame:Brazilian Journal of Otorhinolaryngology
instname:Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF)
instacron:ABORL-CCF
instname_str Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF)
instacron_str ABORL-CCF
institution ABORL-CCF
reponame_str Brazilian Journal of Otorhinolaryngology
collection Brazilian Journal of Otorhinolaryngology
repository.name.fl_str_mv Brazilian Journal of Otorhinolaryngology - Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF)
repository.mail.fl_str_mv revista@aborlccf.org.br||revista@aborlccf.org.br
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