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Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities
The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A retrospective, match-paired analysis of 86 patients who developed fistula after total laryngectomy was carried out and compared wi...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Pacini Editore SRL
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755046/ https://www.ncbi.nlm.nih.gov/pubmed/26900245 http://dx.doi.org/10.14639/0392-100X-626 |
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author | BUSONI, M. DEGANELLO, A. GALLO, O. |
author_facet | BUSONI, M. DEGANELLO, A. GALLO, O. |
author_sort | BUSONI, M. |
collection | PubMed |
description | The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A retrospective, match-paired analysis of 86 patients who developed fistula after total laryngectomy was carried out and compared with a control group of 86 patients without fistula, randomly selected from a pool of 352 total laryngectomies, performed between January 1999 to October 2014. The overall incidence of PCF in the series was 24.4%; we recorded rates of 19.0%, 28.6% and 30.3% following primary total laryngectomy (PTL), salvage laryngectomy post-radiotherapy (RT-STL) and salvage laryngectomy postchemoradiotherapy (CRT-STL), respectively. Multivariate analysis revealed that the relative risk of fistula was respectively 2.47, 3.09 and 7.69 for hypoalbuminaemia ≤3.5 g/dL, RT-STL and CRT-STL. An early onset of PCF within 10 postoperative days was recorded in case of salvage total laryngectomy. The management of PCF significantly differed between PTL, RT-STL and CTRT-STL, with exclusive conservative treatment for PTL (93.55%), while in the CRT-STL group surgical closure with regional flaps (58.82%) prevailed. Conservative management, adjuvant hyperbaric oxygen therapy and surgical closure were equally distributed in the RT-STL group. Thorough knowledge of patient-related risk factors and its prognostic value, allows the surgeon to better evaluate preventive strategies with the aim of minimising fistula formation, hospitalisation times and related costs. |
format | Online Article Text |
id | pubmed-4755046 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Pacini Editore SRL |
record_format | MEDLINE/PubMed |
spelling | pubmed-47550462016-02-19 Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities BUSONI, M. DEGANELLO, A. GALLO, O. Acta Otorhinolaryngol Ital Laryngology The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A retrospective, match-paired analysis of 86 patients who developed fistula after total laryngectomy was carried out and compared with a control group of 86 patients without fistula, randomly selected from a pool of 352 total laryngectomies, performed between January 1999 to October 2014. The overall incidence of PCF in the series was 24.4%; we recorded rates of 19.0%, 28.6% and 30.3% following primary total laryngectomy (PTL), salvage laryngectomy post-radiotherapy (RT-STL) and salvage laryngectomy postchemoradiotherapy (CRT-STL), respectively. Multivariate analysis revealed that the relative risk of fistula was respectively 2.47, 3.09 and 7.69 for hypoalbuminaemia ≤3.5 g/dL, RT-STL and CRT-STL. An early onset of PCF within 10 postoperative days was recorded in case of salvage total laryngectomy. The management of PCF significantly differed between PTL, RT-STL and CTRT-STL, with exclusive conservative treatment for PTL (93.55%), while in the CRT-STL group surgical closure with regional flaps (58.82%) prevailed. Conservative management, adjuvant hyperbaric oxygen therapy and surgical closure were equally distributed in the RT-STL group. Thorough knowledge of patient-related risk factors and its prognostic value, allows the surgeon to better evaluate preventive strategies with the aim of minimising fistula formation, hospitalisation times and related costs. Pacini Editore SRL 2015-12 /pmc/articles/PMC4755046/ /pubmed/26900245 http://dx.doi.org/10.14639/0392-100X-626 Text en © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/ |
spellingShingle | Laryngology BUSONI, M. DEGANELLO, A. GALLO, O. Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities |
title | Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities
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title_full | Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities
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title_fullStr | Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities
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title_full_unstemmed | Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities
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title_short | Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities
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title_sort | pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities |
topic | Laryngology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755046/ https://www.ncbi.nlm.nih.gov/pubmed/26900245 http://dx.doi.org/10.14639/0392-100X-626 |
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