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

2 Citations (Scopus)

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 1 2019

Fingerprint

Laryngectomy
Fistula
Reoperation
Hypopharynx
Deglutition
Muscles
Chemoradiotherapy
Larynx
Squamous Cell Carcinoma

Keywords

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

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

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
Microvascular Committee of the American Academy of Otolaryngology-Head & Neck Surgery*. / Salvage laryngectomy and laryngopharyngectomy : Multicenter review of outcomes associated with a reconstructive approach. In: Head and Neck. 2019 ; Vol. 41, No. 1. pp. 16-29.
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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.",
keywords = "hypopharyngeal reconstruction, hypopharyngeal squamous cell carcinoma, laryngeal squamous cell carcinoma, microvascular, pharyngocutaneous fistula, recurrent laryngeal cancer, salvage laryngectomy",
author = "{Microvascular Committee of the American Academy of Otolaryngology-Head & Neck Surgery*} and Oxford, {Lance E.} and Mark Urken and Cathy Lazarus and Jenna Cheney and Joseph Scharpf and Fritz, {Michael A.} and Liana Puscas and Mlynarek, {Alex M.} and Eyal Sela and Badr Ibrahim and Hier, {Michael P.} and Hanasono, {Matthew M.} and Peirong Yu and Hornig, {Joshua D.} and Brett Miles and Marita Teng and Eric Genden and Patel, {Urjeet A} and Lin, {Alice C.} and Malone, {James P.} and Rosenthal, {Eben L.} and Lisa Clemons and Han Zhang and O'Connell, {Daniel A.} and Khalid Ansari and Harris, {Jeffrey R.} and Hadi Seikaly and Moreno, {Mauricio A.} and Quang Luu and Joel Jacobson and Farwell, {D. Gregory} and Keith Blackwell and Soroush Zaghi and Vishad Nabili and Wang, {Steven J.} and Burgess, {Bridget C.} and Keith Casper and Julie Goddard and Rodrigo Bayon and Pagedar, {Nitin A.} and Chang, {Kristi E.} and Hoffman, {Henry T.} and Yelizaveta Shnayder and Justin Bond and Sykes, {Kevin J.} and Girod, {Douglas A.} and Tsue, {Terance T.} and Gal, {Thomas J.} and Way, {Thomas Justin} and Leibowitz, {Jason M.}",
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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, vol. 41, no. 1, pp. 16-29. https://doi.org/10.1002/hed.25192

Salvage laryngectomy and laryngopharyngectomy : Multicenter review of outcomes associated with a reconstructive approach. / Microvascular Committee of the American Academy of Otolaryngology-Head & Neck Surgery*.

In: Head and Neck, Vol. 41, No. 1, 01.01.2019, p. 16-29.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Salvage laryngectomy and laryngopharyngectomy

T2 - Multicenter review of outcomes associated with a reconstructive approach

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

AU - Oxford, Lance E.

AU - Urken, Mark

AU - Lazarus, Cathy

AU - Cheney, Jenna

AU - Scharpf, Joseph

AU - Fritz, Michael A.

AU - Puscas, Liana

AU - Mlynarek, Alex M.

AU - Sela, Eyal

AU - Ibrahim, Badr

AU - Hier, Michael P.

AU - Hanasono, Matthew M.

AU - Yu, Peirong

AU - Hornig, Joshua D.

AU - Miles, Brett

AU - Teng, Marita

AU - Genden, Eric

AU - Patel, Urjeet A

AU - Lin, Alice C.

AU - Malone, James P.

AU - Rosenthal, Eben L.

AU - Clemons, Lisa

AU - Zhang, Han

AU - O'Connell, Daniel A.

AU - Ansari, Khalid

AU - Harris, Jeffrey R.

AU - Seikaly, Hadi

AU - Moreno, Mauricio A.

AU - Luu, Quang

AU - Jacobson, Joel

AU - Farwell, D. Gregory

AU - Blackwell, Keith

AU - Zaghi, Soroush

AU - Nabili, Vishad

AU - Wang, Steven J.

AU - Burgess, Bridget C.

AU - Casper, Keith

AU - Goddard, Julie

AU - Bayon, Rodrigo

AU - Pagedar, Nitin A.

AU - Chang, Kristi E.

AU - Hoffman, Henry T.

AU - Shnayder, Yelizaveta

AU - Bond, Justin

AU - Sykes, Kevin J.

AU - Girod, Douglas A.

AU - Tsue, Terance T.

AU - Gal, Thomas J.

AU - Way, Thomas Justin

AU - Leibowitz, Jason M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - hypopharyngeal reconstruction

KW - hypopharyngeal squamous cell carcinoma

KW - laryngeal squamous cell carcinoma

KW - microvascular

KW - pharyngocutaneous fistula

KW - recurrent laryngeal cancer

KW - salvage laryngectomy

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U2 - 10.1002/hed.25192

DO - 10.1002/hed.25192

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AN - SCOPUS:85060120484

VL - 41

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EP - 29

JO - Head and Neck Surgery

JF - Head and Neck Surgery

SN - 1043-3074

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