Abstract
Objectives:
The authors of the RTOG 91-11 study recently presented long-term outcomes for 3 nonsurgical treatment strategies to preserve the larynx in patients with locally advanced laryngeal cancer. They concluded that concomitant chemotherapy and radiation is optimal for laryngeal preservation; however, 16% of the patients still required total laryngectomies (TL). Additionally, the incidence of pharyngocutaneous fistulas was 30% within this cohort receiving total laryngectomy. We therefore conducted a single center retrospective study of 47 patients treated with total laryngectomy at a tertiary care center from July 2004 to May 2013 to assess the percentage of patients that develop pharyngocutaneous fistula. We propose that the rate of pharyngocutaneous fistula in patients that receive TL will be lower using the technique of flap augmentation compared with the patients that receive TL using the technique of primary closure.
Methods:
Thirty-two patients received primary closure for TL with a pharyngocutaneous rate of 9.4% (n = 3), and 14 patients received flap augmentation for TL with a pharyngocutaneous rate of 7.1% (n = 1). We also assessed stage of laryngeal cancer; whether the patient received cheomotherapy, radiation therapy, or concomitant radiation and chemotherapy; the muscle used for flap closure; recipient artery and vein; thyroid-stimulating hormone, hemoglobin, intact parathyroid hormone, and albumin preoperative and postoperative values, when available.
Results/Conclusions:
The rate of pharyngocutaneous fistula was comparable between the primary closure group and the flap closure group (P = 1). However, because of the low rate of pharyngocutaneous fistulas, it would be necessary to analyze a larger cohort to determine significance and possible confounding factors.
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