Factors predicting pharyngocutaneous fistula in patients after salvage laryngectomy for laryngeal malignancy – A multicenter collaborative cohort study Journal Article
| Authors: | Fitzgerald, C. W. R.; Davies, J. C.; de Almeida, J. R.; Rich, J. T.; Orsini, M.; Eskander, A.; Monteiro, E.; Mimica, X.; Mclean, T.; Cracchiolo, J. R.; Ganly, I.; Hessel, A.; Tam, S.; Wei, D.; Goepfert, R.; Su, J.; Xu, W.; Zafereo, M.; Goldstein, D. P.; Cohen, M. A. |
| Article Title: | Factors predicting pharyngocutaneous fistula in patients after salvage laryngectomy for laryngeal malignancy – A multicenter collaborative cohort study |
| Abstract: | Objectives: Pharyngocutaneous fistula (PCF) is a major morbidity of salvage total laryngectomy (TL). Understanding the factors predicting PCF is fundamental to managing laryngeal cancer. We aim to assess factors associated with PCF following salvage TL in a multicenter, international retrospective cohort study of academic centers in the US and Canada. Results: In total, 550 patients post-salvage TL were identified (mean [SD; range] age, 64 [10.4; 32–90] years; 465 [85 %] male and 84 [15 %] female) between 2000 and 2014. Rate of PCF was 23 % (n = 127) with median time to PCF of 2.9 weeks. Surgical management of PCF was required in 43 % (n = 54) while 57 % (n = 73) required wound care alone. Rates of PCF differed by primary treatment modality [radiation, 20 % (n = 76); chemoradiation, 27 % (n = 40); not available (n = 6)] and use of vascularized tissue in pharyngeal closure [free/regional flap, 18 % (n = 25); no vascularized tissue/primary closure, 24 % (n = 98); not available (n = 4)]. There was no statistically significant association between PCF and treatment with chemoradiation (HR, 1.32; 95 % CI, 0.91–1.93, p = 0.14) or lack of vascularized tissue reconstruction (HR, 1.41, 95 % CI 0.91–2.18, p = 0.12). Significant association between PCF and advanced stage (T3 or T4), positive margin, close margin (<5mm), lymphovascular invasion and pre-operative tracheostomy were identified on univariable analysis. Positive surgical margin (HR, 1.91; 95 % CI, 1.11 to 3.29) was the only significant association on multivariable analysis. Conclusion: We highlight positive surgical margin as the only variable significantly associated with increased risk of PCF following salvage TL on multivariable analysis in a large cohort across several major head and neck oncology centers. © 2022 |
| Keywords: | laryngectomy; surgery; pharyngocutaneous fistula; head and neck malignancy; laryngeal squamous cell carcinoma |
| Journal Title: | Oral Oncology |
| Volume: | 134 |
| ISSN: | 1368-8375 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-11-01 |
| Start Page: | 106089 |
| Language: | English |
| DOI: | 10.1016/j.oraloncology.2022.106089 |
| PROVIDER: | scopus |
| PUBMED: | 36057225 |
| PMCID: | PMC10190204 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 October 2022 -- Source: Scopus |
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130Cohen -
14Mimica -
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Fitzgerald -
9
Mclean
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