Post-Laryngectomy stricture and pharyngocutaneous fistula

Review of techniques in primary pharyngeal reconstruction in laryngectomy

B. Walton, J. Vellucci, P. B. Patel, Kristofer Jennings, S. Mccammon, Michael Underbrink

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: The purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy. Study Design: Retrospective Chart Review. Methods: We retrospectively reviewed a total of 151 patients over a 20-year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture postoperatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modelling, we performed univariate and multivariate analyses of our data. Results: The overall PCF and post-laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (P=.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (P=.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, P=.033, vertical, P=.037), while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (P=.63). Conclusion: Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.

Original languageEnglish (US)
JournalClinical Otolaryngology
DOIs
StateAccepted/In press - 2017

Fingerprint

Laryngectomy
Fistula
Pathologic Constriction
Cutaneous Fistula
Multivariate Analysis
Retrospective Studies
Logistic Models

Keywords

  • Fistula
  • Pharyngeal closure
  • Post-laryngectomy stricture
  • T-type closure
  • Vertical closure

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Post-Laryngectomy stricture and pharyngocutaneous fistula : Review of techniques in primary pharyngeal reconstruction in laryngectomy. / Walton, B.; Vellucci, J.; Patel, P. B.; Jennings, Kristofer; Mccammon, S.; Underbrink, Michael.

In: Clinical Otolaryngology, 2017.

Research output: Contribution to journalArticle

@article{8ec9cd9ae9a24453874cfe7b3aae959b,
title = "Post-Laryngectomy stricture and pharyngocutaneous fistula: Review of techniques in primary pharyngeal reconstruction in laryngectomy",
abstract = "Objective: The purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy. Study Design: Retrospective Chart Review. Methods: We retrospectively reviewed a total of 151 patients over a 20-year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture postoperatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modelling, we performed univariate and multivariate analyses of our data. Results: The overall PCF and post-laryngectomy stricture rates were 19.1{\%} and 15.8{\%}. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (P=.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (P=.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, P=.033, vertical, P=.037), while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (P=.63). Conclusion: Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.",
keywords = "Fistula, Pharyngeal closure, Post-laryngectomy stricture, T-type closure, Vertical closure",
author = "B. Walton and J. Vellucci and Patel, {P. B.} and Kristofer Jennings and S. Mccammon and Michael Underbrink",
year = "2017",
doi = "10.1111/coa.12905",
language = "English (US)",
journal = "Clinical Otolaryngology",
issn = "1749-4478",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Post-Laryngectomy stricture and pharyngocutaneous fistula

T2 - Review of techniques in primary pharyngeal reconstruction in laryngectomy

AU - Walton, B.

AU - Vellucci, J.

AU - Patel, P. B.

AU - Jennings, Kristofer

AU - Mccammon, S.

AU - Underbrink, Michael

PY - 2017

Y1 - 2017

N2 - Objective: The purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy. Study Design: Retrospective Chart Review. Methods: We retrospectively reviewed a total of 151 patients over a 20-year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture postoperatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modelling, we performed univariate and multivariate analyses of our data. Results: The overall PCF and post-laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (P=.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (P=.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, P=.033, vertical, P=.037), while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (P=.63). Conclusion: Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.

AB - Objective: The purpose of this study was to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy. Study Design: Retrospective Chart Review. Methods: We retrospectively reviewed a total of 151 patients over a 20-year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture postoperatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modelling, we performed univariate and multivariate analyses of our data. Results: The overall PCF and post-laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (P=.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (P=.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, P=.033, vertical, P=.037), while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (P=.63). Conclusion: Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.

KW - Fistula

KW - Pharyngeal closure

KW - Post-laryngectomy stricture

KW - T-type closure

KW - Vertical closure

UR - http://www.scopus.com/inward/record.url?scp=85020463340&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020463340&partnerID=8YFLogxK

U2 - 10.1111/coa.12905

DO - 10.1111/coa.12905

M3 - Article

JO - Clinical Otolaryngology

JF - Clinical Otolaryngology

SN - 1749-4478

ER -