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Leroy C, Brunet A, Touska P, Atallah S, Simo R, Arora A, Jeannon JP, Oakley R, Rovira A. Water soluble swallow for leak detection after total laryngectomy post radiotherapy. Eur Arch Otorhinolaryngol 2023; 280:4225-4232. [PMID: 37210463 DOI: 10.1007/s00405-023-08016-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
AIM Pharyngeal leak (PL) and pharyngocutaneous fistula (PCF) are serious complications following total laryngectomy and their incidence is higher in the salvage setting. The aim of this study is to describe the accuracy of water soluble swallow (WSS) to rule out salivary postoperative leak after salvage total laryngectomy (STL) to expedite start of oral intake. MATERIAL AND METHODS Retrospective study including patients undergoing STL between 2008 and 2021 at Guy's Hospital. WSS was routinely performed within 15 days post operation. RESULTS Sixty-six patients underwent STL. Nine developed clinically diagnosed PCF; one died before having WSS. Fifty-six patients underwent WSS post STL. WSS was performed within 15 days after STL when no postoperative complications occurred (76.8%). Among patients undergoing WSS with no clinical suspicion for fistula (56), PL was identified in 15 cases (26.8%). They were managed conservatively; PCF was avoided in 7(46.7%) cases. Three patients (7.3%) developed PCF after having started oral intake with a negative WSS. These three cases were further analysed, 2 cases where recorded at the beginning of the studied period when less experience was available possibly leading to incorrect results. Sensitivity and negative predictive value (NPV) for fistula prediction were 72.7% and 92.7%, respectively. CONCLUSION Taking into account the high NPV of WSS, it is safe to start oral intake after negative WSS. Further studies to evaluate its accuracy earlier on after SLT are justified taking into account the results and the impact that delayed feeding has on patient's quality of life.
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Affiliation(s)
- Charlotte Leroy
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
| | - Aina Brunet
- Department of Head and Neck Surgery, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Insitut d'Investigació Biomèdica de Bellvitge, Avinguda de la Granvia de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Philip Touska
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Sarah Atallah
- Department of Head and Neck Surgery, Tenon Hospital, 4 Rue de la Chine, 75020, Paris, France
| | - Ricard Simo
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Asit Arora
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Jean-Pierre Jeannon
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Richard Oakley
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Aleix Rovira
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
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Song D, Li Z, Zhou X, Zhang Y, Peng X, Zhou B, Lü C, Wu P, Tang Y, Peng W, Mao H, Liu Z. [Clinical application of pedicled chimeric thoracoacromial artery perforator flap for circular hypopharyngeal reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1441-1445. [PMID: 30417621 PMCID: PMC8414110 DOI: 10.7507/1002-1892.201802017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/10/2018] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of pedicled chimeric thoracoacromial artery perforator (TAAP) flap as a reconstructive option for circular hypopharyngeal defects. Methods Between January 2013 and December 2014, the pedicled chimeric TAAP flap was used to repair oncologic circular hypopharyngeal defects in 8 patients, included 6 males and 2 females, with an average age of 57 years (range, 45-80 years). All patients were treated in other hospitals before and recurrence was noted. The duration between latest treatment and recurrence ranged from 3 to 28 months (mean, 16.5 months). According to Union for International Cancer Control (UICC) TNM staged, 3 cases were T 2N 1M 0, 2 cases were T 3N 1M 0, 1 case was T 3N 2M 0, 2 cases were T 4N 1M 0. After laryngectomy, the size of circular hypopharyngeal defect ranged from 9.0 cm×8.5 cm to 12.0 cm×10.5 cm. The size of TAAP flap ranged from 7.0 cm×4.0 cm to 9.5 cm×6.0 cm.The size of pectoralis major flap ranged from 9.0 cm×5.0 cm to 14.5 cm×6.0 cm.The donor sites were closed directly in all cases. Results Postoperatively all flaps survived smoothly, and all defects healed by first intention. No early complication was noted. The mean hospital stay period ranged from 12 to 22 days (mean, 14.5 days). All patients were followed up 12-45 months (mean, 18.7 months). Patients possessed good appearance of surgical sites. No recurrence, fistulas, stenosis/strictures, dehiscence, or swelling occurred. Only linear scars were left on the donor sites, and the pectoralis major muscle function was completely preserved in all patients. Conclusion Patients with high comorbidities may not be suitable candidates for free flap reconstruction, especially when the recipient vessels are affected from disease or radiotherapy. Pedicled chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defects in such conditions..
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008,
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, P.R.China
| | - Xiaowei Peng
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Peng Wu
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yuanyuan Tang
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Wen Peng
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Huangxing Mao
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zeyang Liu
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
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Kiong KL, Tan NC, Skanthakumar T, Teo CEH, Soo KC, Tan HK, Roche E, Yee K, Iyer NG. Salivary fistula: Blue dye testing as part of an algorithm for early diagnosis. Laryngoscope Investig Otolaryngol 2017; 2:363-368. [PMID: 29299509 PMCID: PMC5743154 DOI: 10.1002/lio2.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/18/2017] [Accepted: 09/06/2017] [Indexed: 11/10/2022] Open
Abstract
Objective Orocutaneous and pharyngocutaneous fistula (OPCF) is a debilitating complication of head and neck surgery for squamous cell carcinoma (SCC), resulting in delayed adjuvant treatment and prolonged hospitalization. As yet, there is no established test that can help in prompt and accurate diagnosis of OPCF. This study aims to determine the accuracy of bedside blue dye testing and its role as part of an algorithm for early diagnosis. We also analyze the risk factors predisposing to OPCF. Study Design Retrospective cohort study from 2012 to 2014. Methods Patients with head and neck SCC who underwent major resection and reconstruction, at risk of OPCF, were included. Results of blue‐dye and video‐fluoroscopic swallow‐studies (VFSS) testing for OPCF were recorded. For the patients that were noted to develop OPCF, the length of time to diagnosis of fistula and subsequent mode of management were examined. Results Of the 93 patients in this study, 25 (26.9%) developed OPCF. Advanced T‐classification (T3/T4) was the only significant predisposing risk factor (p = 0.013). The sensitivity and specificity of the bedside blue dye testing was found to be 36.4% and 100%, respectively. The test positive patients were diagnosed with OPCF at a median of postoperative day (POD) 9.5 as compared to POD 13 for the test negative patients (p = 0.001). Early diagnosis was associated with faster fistula resolution with treatment. Conclusion Blue dye testing is a simple bedside test that can assist in the early diagnosis of OPCF in patients, allowing treatment to be instituted earlier with improved outcomes. Level of Evidence 3
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Affiliation(s)
| | | | | | | | - Khee Chee Soo
- the Division of Surgical Oncology National Cancer Centre Singapore
| | | | - Elizabeth Roche
- Department of Speech Therapy Singapore General Hospital Singapore
| | - Kaisin Yee
- Department of Speech Therapy Singapore General Hospital Singapore
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Doerfer J, Meyer T, Klein P, Melling N, Kerscher AG, Hohenberger W, Pelz JO. The importance of radiological controls of anastomoses after upper gastrointestinal tract surgery - a retrospective cohort study. Patient Saf Surg 2010; 4:17. [PMID: 21070633 PMCID: PMC2994795 DOI: 10.1186/1754-9493-4-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 11/11/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This study was designed to analyze whether routine radiological controls of anastomoses in the upper gastrointestinal tract an early detection of anastomotic leaks. PATIENTS AND METHODS 135 patients who underwent upper gastrointestinal tract surgery were retrospectively analyzed. Patients in the first group (n = 55) underwent routine radiological control of the anastomoses. In the second group (n = 80) the radiological control was only performed in case of clinical symptoms or signs of anastomotic leaks. RESULTS The incidence of anastomotic leaks in the patients seen by us was 5.2%, equivalent to 7 of 135 patients In Group 1 leaks were seen in 4 of 55 patients (7,2%) in group 2 leaks were seen in 3 of 80 (3,8%). The radiological control of the anastomoses with contrast swallow showed the leakage in two cases. Twice the results were false negative. The sensitivity of computed tomography was 100%. DISCUSSION Routine radiological control of anastomoses with contrast swallow only has low sensitivity. This procedure should not be performed routinely any more.The radiological control should be used in cases with signs of anastomotic leakage or with postoperatively impaired gastrointestinal passage.
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Affiliation(s)
- Joerg Doerfer
- Department of Surgery, University of Erlangen-Nuremberg, Germany.
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Joo YH, Sun DI, Cho KJ, Park JO, Kim MS. Fasciocutaneous free flap reconstruction for squamous cell carcinoma of the hypopharynx. Eur Arch Otorhinolaryngol 2010; 268:289-94. [PMID: 20721571 DOI: 10.1007/s00405-010-1367-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 08/12/2010] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to examine functional and surgical outcomes after fasciocutaneous free flap reconstruction of the hypopharynx. A retrospective review of the records of 48 consecutive patients that underwent hypopharyngectomy and reconstruction using fasciocutaneous free flaps between 1996 and 2009 was performed. Flap donor sites included the radial forearm (n = 42), anterolateral thigh (n = 5), and lateral thigh (n = 1). There was no perioperative mortality, and the free flap survival rate was 95.8%. Five (10.4%) patients developed a postoperative pharyngocutaneous fistula. In three (6.3%) patients a stricture developed during the postoperative period. Forty-four (92%) patients were decannulated and maintained their voice. Forty-four (92%) patients were able to take oral nutrition, although 4 (8%) needed additional PEG-tube feeding. Five-year overall and disease-specific survival rates were 56 and 61%, respectively. Functional reconstruction of extensive laryngohypopharyngeal defects can be achieved using fasciocutaneous free flaps with favorable functional and surgical results.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otolaryngology-HNS, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu Panpo-dong 505, Seoul 137-040, Korea
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van la Parra RFD, Kon M, Schellekens PPA, Braunius WW, Pameijer FA. The prognostic value of abnormal findings on radiographic swallowing studies after total laryngectomy. Cancer Imaging 2007; 7:119-25. [PMID: 17562591 PMCID: PMC1892601 DOI: 10.1102/1470-7330.2007.0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2007] [Indexed: 11/16/2022] Open
Abstract
Pharyngocutaneous fistulae are a common complication after total laryngectomy. Our study evaluates the correlation of postoperative radiographic swallowing studies and clinical symptoms. We also propose a grading system to classify leaks radiographically. The records of 45 patients who underwent total laryngectomy were retrospectively reviewed. All patients had a radiographic swallowing study (RSS) on or around the tenth postoperative day. A grading system was developed to classify radiographic findings (grade 0-5). Twenty-two patients had an abnormal RSS (grade 2-5). Three patients (13.6%) had clinical signs of impending fistula whereas radiography showed moderate leakage (grade 3) in one patient and a pharyngocutaneous fistula (grade 5) in two. The other 19 patients with radiographically demonstrated leakage had no clinical signs of anastomotic complications. After total laryngectomy, radiography may reveal anastomotic complications of varying severity. The grading system used in this study enabled us to objectively classify the radiological abnormalities on swallowing studies. Because most radiographic leakages were clinically silent and not all clinically apparent fistula were radiographically visible in our study, the role of routine postoperative radiographic swallowing studies in the absence of clinical signs or fistula remains unclear.
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Affiliation(s)
- R F D van la Parra
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Lorenz RR, Alam DS. The increasing use of enteral flaps in reconstruction for the upper aerodigestive tract. Curr Opin Otolaryngol Head Neck Surg 2003; 11:230-5. [PMID: 14515068 DOI: 10.1097/00020840-200308000-00002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The enteric flaps commonly used in free tissue head and neck reconstruction include the gastro-omental flap, the omental flap, and the free jejunal flap. These flaps have demonstrated excellent reconstructive results for defects of the oral cavity, oropharynx, hypopharynx, cervical esophagus, and contouring defects of the head and neck. Their main advantages include tissue pliability, tubed shape, ease of contouring, and the ability to secrete mucus. Recent studies report outcome measurements for flap loss, fistula rates, postoperative swallowing, speech, and cosmesis. Now that experience has been gained to the point of routine use of these flaps, randomized trials are needed to determine the functional advantages of the enteric flaps compared with other reconstructive options.
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Affiliation(s)
- Robert R Lorenz
- Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Abstract
The occurrence of pharyngocutaneous fistula after oncologic head and neck surgery is a serious complication. It is the most common complication after major hypopharyngeal and laryngeal ablative surgery. The cause and management guidelines are still controversial. Contributing risk factors of impaired wound healing should be recognized in preoperative planning. Perioperative technical issues and preventive postoperative care play a major role in the prevention of fistulae, limiting the severity of the fistula and minimizing secondary complications. Surgical salvage of cancers treated with organ preservation approaches is associated with higher rates of postoperative complications, particularly in cases in which mucosal membranes are transgressed and surgically closed. Patients who require surgical repair are best treated by the use of regional myocutaneous flaps or free tissue transfers. This subset of patients is likely best treated in regional centers of excellence with well developed multidisciplinary programs for ablative and reconstructive head and neck surgery.
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Affiliation(s)
- Antti A Mäkitie
- Toronto General Hospital, Eaton North 7-242, 200 Elizabeth Street, Toronto, ON, M5G 2C4 Canada.
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Update on microvascular free tissue transfer: new trends and applications. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200008000-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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