Stapler Use in Salvage Total Laryngectomy: A Useful Tool?

Area of Science:

• Otolaryngology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Salvage total laryngectomy is a complex procedure for recurrent laryngeal cancer.
• Pharyngocutaneous fistula is a significant complication impacting patient recovery.
• Optimizing surgical techniques is crucial for improving outcomes in salvage laryngectomy.

Purpose of the Study:

• To compare the benefits of using a surgical stapler versus manual suture in salvage total laryngectomy.
• To analyze the impact on surgical time, hospitalization duration, and oral feeding resumption.
• To evaluate the incidence of pharyngocutaneous fistula and associated risk factors.

Main Methods:

• Retrospective analysis of 114 patients undergoing salvage total laryngectomy.
• Patients were divided into two groups: mechanical stapler suture (Group A) and manual suture (Group B).
• Comparison of surgical time, oral feeding start, hospitalization length, margin status, and fistula rates, considering risk factors like diabetes and prior radiation.

Main Results:

• Stapler use (Group A) resulted in significantly shorter oral feeding restarting time (15 vs. 20 days), hospitalization (17.6 vs. 23.7 days), and surgery duration (268 vs. 294 minutes) compared to manual suture (Group B).
• Infiltrated surgical margins were less frequent in Group A (4.3%) vs. Group B (17.6%).
• Pharyngocutaneous fistula incidence was 15.2% in Group A and 20.6% in Group B. Fistula rates were higher in diabetic patients (38.9%) and those with prior radiation (90.5% of fistulas).

Conclusions:

• Mechanical stapler use in salvage total laryngectomy is associated with reduced operative time, shorter hospital stays, and earlier oral feeding.
• The stapler technique may potentially decrease the rate of pharyngocutaneous fistula.
• Further studies are warranted to confirm the preventive role of mechanical pharyngeal suture in salvage laryngectomy.