Journal
HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK
Volume 41, Issue 1, Pages 16-29Publisher
WILEY
DOI: 10.1002/hed.25192
Keywords
hypopharyngeal reconstruction; hypopharyngeal squamous cell carcinoma; laryngeal squamous cell carcinoma; microvascular; pharyngocutaneous fistula; recurrent laryngeal cancer; salvage laryngectomy
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Background Surgeons have developed various reconstructive techniques to minimize the rate of pharyngocutaneous fistula and optimize functional outcome after salvage laryngectomy or laryngopharyngectomy. Methods Multicenter retrospective review at 33 institutions of 486 patients with a history of squamous cell carcinoma (SCC) of the larynx or hypopharynx previously treated with primary chemoradiotherapy (CRT) who required salvage surgery. Outcomes evaluated were overall fistula rate, fistula requiring reoperation, and 12-month speech and swallowing function. Results Primary closure of the hypopharynx was associated with a statistically higher overall fistula rate and fistula requiring reoperation compared to reconstruction with vascularized tissue augmentation. Vascularized tissue augmentation with muscle led to worse 12-month understandability of speech and nutritional mode scores compared to vascularized tissue augmentation without muscle. Conclusion Vascularized tissue augmentation reduces the overall fistula rate and fistula requiring reoperation but vascularized tissue augmentation with muscle may impair speech and swallowing outcomes.
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