09-11, 11:15–11:45 (Europe/Istanbul), Head & Neck Surgery 4
Background & Aim:
Pharyngocutaneous fistula (PCF) is the most common complication following salvage laryngectomy (SLE). The preventive use of a pectoralis major flap (PMF) is one strategy to reduce the incidence of PCF. The aim of this study was to evaluate whether the use of PMF in SLE reduces the incidence of PCF.
Material & Methods:
In this retrospective study, patients who underwent SLE were divided into two groups according to the presence or absence of PCF. The groups were compared with respect to the use of PMF using the chi-square and Fisher’s exact tests.
Results:
PCF developed in 39.3% of patients after SLE. Overall, a PMF was used in 34 patients (23.3%), including seven cases (20.6%) in which it was applied prophylactically. The use of PMF did not significantly reduce the incidence of PCF (p = 0.407). Furthermore, no significant differences were found between prophylactic and reconstructive use of PMF (p = 0.427 and p = 0.353, respectively).
Conclusions:
In our series, the preventive use of PMF in SLE did not reduce the incidence of PCF. However, the literature largely supports the effectiveness of vascularized flaps in preventing PCF; therefore, when risk factors are carefully considered, routine use of PMF remains justified.
1: Šifrer R, Urbančič J, Piazza C, van Weert S, García-Purriños F, Benedik J, Tancer I, Aničin A. Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations. Eur Arch Otorhinolaryngol. 2021 Jul;278(7):2209-2217. doi: 10.1007/s00405-020-06318-8. Epub 2020 Sep 5. PMID: 32889621; PMCID: PMC7473826.
2: Šifrer R, Benedik J, Aničin A. Elective open "Shield Tracheostomy" in patients with COVID-19. Eur Arch Otorhinolaryngol. 2022 Feb;279(2):891-897. doi: 10.1007/s00405-021-06820-7. Epub 2021 Apr 21. PMID: 33881578; PMCID: PMC8059421.
3: Šifrer R, Strojan P, Tancer I, Dolenc M, Fugina S, Zore SB, Aničin A. The Incidence and the Risk Factors for Pharyngocutaneous Fistula following Primary and Salvage Total Laryngectomy. Cancers (Basel). 2023 Apr 12;15(8):2246. doi: 10.3390/cancers15082246. PMID: 37190174; PMCID: PMC10136624.
4: Šifrer R, Aničin A, Pohar MP, Žargi M, Pukl P, Soklič T, Strojan P. Pharyngocutaneous fistula: the incidence and the risk factors. Eur Arch Otorhinolaryngol. 2016 Oct;273(10):3393-9. doi: 10.1007/s00405-016-3963-z. Epub 2016 Mar 8. PMID: 26956981.
5: Šifrer R, Dolenc M, Zore SB, Fugina S, Jesenko L, Strojan P. Temporal Variability in the Incidence and Risk Factors for Pharyngocutaneous Fistula Development after Total Laryngectomy. Cancers (Basel). 2024 Oct 15;16(20):3486. doi: 10.3390/cancers16203486. PMID: 39456580; PMCID: PMC11506730.
6: Šifrer R, Rijken JA, Leemans CR, Eerenstein SEJ, van Weert S, Hendrickx JJ, Bloemena E, Heuveling DA, Rinkel RNPM. Evaluation of vascular features of vocal cords proposed by the European Laryngological Society. Eur Arch Otorhinolaryngol. 2018 Jan;275(1):147-151. doi: 10.1007/s00405-017-4791-5. Epub 2017 Oct 30. PMID: 29086006; PMCID: PMC5754403.
7: Šifrer R, Šereg-Bahar M, Gale N, Hočevar-Boltežar I. The diagnostic value of perpendicular vascular patterns of vocal cords defined by narrow-band imaging. Eur Arch Otorhinolaryngol. 2020 Jun;277(6):1715-1723. doi: 10.1007/s00405-020-05864-5. Epub 2020 Feb 28. PMID: 32112142.
8: Sifrer R, Strojan P, Zidar N, Zargi M, Groselj A, Krajinovic M. Distant metastasis of rectal adenocarcinoma in a temporary tracheostoma. Radiol Oncol. 2014 Nov 5;48(4):393-6. doi: 10.2478/raon-2013-0079. PMID: 25435853; PMCID: PMC4230560.
9: Šifrer R, Urbančič J, Strojan P, Aničin A, Žargi M. The assessment of mucosal surgical margins in head and neck cancer surgery with narrow band imaging. Laryngoscope. 2017 Jul;127(7):1577-1582. doi: 10.1002/lary.26405. Epub 2016 Nov 15. PMID: 27859314.
10: Jensterle S, Benedik J, Sifrer R. Tracheostomy before and during COVID-19 pandemic. Radiol Oncol. 2024 Jun 12;58(4):556-564. doi: 10.2478/raon-2024-0034. PMID: 38861690; PMCID: PMC11604258.