Cesare Piazza1,2, Alberto Paderno3, Francesca Del Bon4, Alberto Grammatica4, Nausica Montalto5, Lorenzo Bresciani1, Lorenzo Giannini1, Fabiola Incandela1, Walter Fontanella1, Piero Nicolai5. 1. Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy. 2. Department of Oncology and Oncohematology, University of Milan, Milan, Italy. 3. Department of Otorhinolaryngology - Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy. albpaderno@gmail.com. 4. Department of Otorhinolaryngology - Head and Neck Surgery, Spedali Civili of Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy. 5. Department of Otorhinolaryngology - Head and Neck Surgery, University of Padua, Padua, Italy.
Abstract
INTRODUCTION: Salvage total laryngectomy (STL) is the most common treatment for recurrent laryngeal cancer after (chemo)-radiotherapy [(C)RT]. In this scenario, a higher rate of local wound complications, such as pharyngo-cutaneous fistula (PCF) and pharyngo-esophageal stenosis (PES), is generally expected. The aim of the present study is to evaluate outcomes using a standardized reconstructive protocol. METHODS: Between 2009 and 2019, patients undergoing STL after (C)RT were collected at two referral hospitals with the objective of evaluating surgical outcomes using a standardized reconstructive policy based on the use of fascio-cutaneous free flaps as inlay patch grafts and a long-lasting salivary bypass stent. RESULTS: Fifty-five patients (mean age, 66 years; male-to-female ratio, 8:1) were included in the study. Previous treatments were RT in 22 (40%) patients, CRT in 21 (38.2%), and partial laryngeal surgery followed by adjuvant (C)RT in 12 (21.8%). Reconstruction was accomplished by radial forearm and anterolateral thigh free flaps in 16 (29.1%) and 39 (70.9%) patients, respectively. Flap success rate was 98.2%. Concerning postoperative complications, we encountered 3 PCFs (5.4%) and 1 PES (1.8%). CONCLUSION: The standardized reconstructive protocol analyzed herein granted significantly lower rates of PCF and PES after STL compared with data available in the literature.
INTRODUCTION: Salvage total laryngectomy (STL) is the most common treatment for recurrent laryngeal cancer after (chemo)-radiotherapy [(C)RT]. In this scenario, a higher rate of local wound complications, such as pharyngo-cutaneous fistula (PCF) and pharyngo-esophageal stenosis (PES), is generally expected. The aim of the present study is to evaluate outcomes using a standardized reconstructive protocol. METHODS: Between 2009 and 2019, patients undergoing STL after (C)RT were collected at two referral hospitals with the objective of evaluating surgical outcomes using a standardized reconstructive policy based on the use of fascio-cutaneous free flaps as inlay patch grafts and a long-lasting salivary bypass stent. RESULTS: Fifty-five patients (mean age, 66 years; male-to-female ratio, 8:1) were included in the study. Previous treatments were RT in 22 (40%) patients, CRT in 21 (38.2%), and partial laryngeal surgery followed by adjuvant (C)RT in 12 (21.8%). Reconstruction was accomplished by radial forearm and anterolateral thigh free flaps in 16 (29.1%) and 39 (70.9%) patients, respectively. Flap success rate was 98.2%. Concerning postoperative complications, we encountered 3 PCFs (5.4%) and 1 PES (1.8%). CONCLUSION: The standardized reconstructive protocol analyzed herein granted significantly lower rates of PCF and PES after STL compared with data available in the literature.
Authors: Arlene A Forastiere; Helmuth Goepfert; Moshe Maor; Thomas F Pajak; Randal Weber; William Morrison; Bonnie Glisson; Andy Trotti; John A Ridge; Clifford Chao; Glen Peters; Ding-Jen Lee; Andrea Leaf; John Ensley; Jay Cooper Journal: N Engl J Med Date: 2003-11-27 Impact factor: 91.245
Authors: Raul Pellini; Barbara Pichi; Paolo Ruscito; Alberto Rinaldi Ceroni; Umberto Caliceti; Giuseppe Rizzotto; Antonio Pazzaia; Pasquale Laudadio; Cesare Piazza; Giorgio Peretti; Diana Giannarelli; Giuseppe Spriano Journal: Head Neck Date: 2008-03 Impact factor: 3.147
Authors: Roberto Puxeddu; Cesare Piazza; Maria C Mensi; Gian Peppino Ledda; Federico Argiolas; Giorgio Peretti Journal: Otolaryngol Head Neck Surg Date: 2004-01 Impact factor: 3.497
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Authors: Armando De Virgilio; Andrea Costantino; Giuseppe Mercante; Fabio Ferreli; Bianca Maria Festa; Elena Russo; Luca Malvezzi; Raul Pellini; Giovanni Colombo; Giuseppe Spriano Journal: Eur Arch Otorhinolaryngol Date: 2022-06-22 Impact factor: 2.503