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Stapler-Assisted Pharyngeal Closure After Total Laryngectomy: A Systematic Review and Meta-Analysis.
Carlos M Chiesa-Estomba1,2, Miguel Mayo-Yanez3,4,5, Jose M Palacios-García6,5
1Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia-Biodonostia Health Research Institute, Calle Doctor Begiristain, #1. CP. 20014, Donostia-San Sebastian, Gipuzkoa-Basque Country, Spain. chiesaestomba86@gmail.com.
Stapler-assisted pharyngeal closure (SAPC) after total laryngectomy (TL) may reduce pharyngocutaneous fistula (PCF) rates. This technique also appears to shorten surgical time and hospital stays, though further trials are needed.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Gastroenterology
Background:
- Pharyngocutaneous fistula (PCF) is a common complication after total laryngectomy (TL).
- Pharyngeal closure with a surgical stapler (SAPC) is a technique to potentially reduce PCF rates.
- SAPC may also decrease surgical time, hospital stay, and expedite oral feeding initiation.
Purpose of the Study:
- To systematically review and meta-analyze literature on stapler-assisted pharyngeal closure (SAPC) after total laryngectomy (TL).
- To evaluate the efficacy of SAPC in reducing pharyngocutaneous fistula (PCF) incidence.
- To assess the impact of SAPC on surgical duration and hospital stay.
Main Methods:
- Systematic review and meta-analysis.
- Inclusion of studies involving patients with laryngeal cancer undergoing TL with stapler pharyngeal closure.
- Analysis of current literature regarding SAPC efficacy post-TL.
Main Results:
- The incidence of PCF was 9.5% in the stapler-assisted suture group (SASG) versus 23.4% in the hand-suture group (HSG) (p=0.01).
- SAPC was associated with a statistically significant reduction in PCF rates.
- Preliminary data suggest SAPC shortens surgical time and hospital stay.
Conclusions:
- Stapler-assisted pharyngeal closure (SAPC) may decrease the risk of pharyngocutaneous fistula (PCF) after total laryngectomy (TL).
- SAPC appears to reduce surgical time and length of hospital stay.
- Prospective randomized trials are necessary to confirm these findings.
