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Djabali EJ, Rotter J, Chheda NN, Amdur RJ, Hitchcock K, Mendenhall W, Dziegielewski PT. Woody hardness classification impact on salvage laryngectomy functional outcomes. Am J Otolaryngol 2021; 42:102877. [PMID: 33485049 DOI: 10.1016/j.amjoto.2020.102877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Post-radiation therapy salvage surgeries are challenging for surgeons due to tissue fibrosis. The woody hardness classification is valuable in differentiating the degree of neck stiffness, but its clinical utility has not been evaluated. We applied it to patients undergoing salvage laryngectomy to study the impact of woody hardness on postoperative outcomes. MATERIALS AND METHODS A retrospective observational study was performed on patients undergoing salvage laryngectomy between 2014 and 2019. Patients were assigned into the A (extremely woody hard), B (moderately woody hard), or C (mildly woody hard) woody hardness class. The primary outcome was pharyngoesophageal stricture development. Secondary outcomes included time to pharyngoesophageal stricture, pharyngocutaneous fistula development, time to pharyngocutaneous fistula, development of post-operative complications, and tracheoesophageal puncture complications. RESULTS Fifty-one patients were included in the study: Class A 1 patient, Class B 30 patients, and Class C 20 patients. The single Class A patient was grouped with the Class B patients. The development of a pharyngoesophageal stricture shows consistent negative association with woody hardness despite most analyses not reaching statistical significance. These associations are robust to a number of confounding variables in multivariate logistic and time to event analyses. Furthermore, the time to event analysis controlling for squamous cell carcinoma diagnosis led to a statistically significant association between woody hardness (i.e., A/B higher risk) and time to stricture (HR=5, p=0.02). CONCLUSIONS This study suggests that this classification may be useful in predicting pharyngoesophageal stricture formation in salvage laryngectomy patients and could be used to implement stricture preventive measures.
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Affiliation(s)
- Emma J Djabali
- College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, USA.
| | - Jason Rotter
- Mathematica, Inc., 1100 First St. NE, #1200, Washington, DC, USA
| | - Neil N Chheda
- Department of Otolaryngology, University of Florida, PO Box 100264 1345, Center Dr., M2-228 MSB, Gainesville, FL, USA
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - Kathryn Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, PO Box 100264 1345, Center Dr., M2-228 MSB, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
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