Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach

Microvascular Committee of the American Academy of Otolaryngology-Head & Neck Surgery*

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)16-29
Number of pages14
JournalHead and Neck
Volume41
Issue number1
DOIs
StatePublished - Jan 2019

Keywords

  • hypopharyngeal reconstruction
  • hypopharyngeal squamous cell carcinoma
  • laryngeal squamous cell carcinoma
  • microvascular
  • pharyngocutaneous fistula
  • recurrent laryngeal cancer
  • salvage laryngectomy

ASJC Scopus subject areas

  • Otorhinolaryngology

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    Microvascular Committee of the American Academy of Otolaryngology-Head & Neck Surgery* (2019). Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach. Head and Neck, 41(1), 16-29. https://doi.org/10.1002/hed.25192