Reconstruction for Salvage Laryngectomy With Limited Pharyngectomy

Area of Science:

• Head and Neck Surgery
• Surgical Oncology
• Reconstructive Surgery

Background:

• Salvage laryngectomy closure technique is debated for optimizing outcomes.
• Head and neck surgeons seek improved methods for postoperative and functional results.

Purpose of the Study:

• To investigate the association between salvage laryngectomy closure techniques and early postoperative/functional outcomes.
• To compare primary mucosal closure (PC), regional closure (RC), and free tissue transfer (FTT) in salvage laryngectomy.

Main Methods:

• Retrospective cohort study of 309 patients from 17 tertiary care centers (2011-2016).
• Patients underwent total laryngectomy with limited pharyngectomy after radiotherapy/chemoradiotherapy.
• Pharyngeal defects reconstructed by PC, RC, or FTT; outcomes analyzed using multivariable regression.

Main Results:

• Free tissue transfer (FTT) was used in 52.1% of patients, regional closure (RC) in 20.7%, and primary closure (PC) in 27.2%.
• Pharyngocutaneous fistula (PCF) rates were 22.4% for FTT, 39.1% for RC, and 34.5% for PC.
• Multivariable analysis showed higher PCF risk with PC (RR, 2.2) and RC (RR, 2.5) versus FTT. FTT reduced PCF risk (RR, 0.6; NNT, 7).
• No significant differences in functional outcomes were observed between groups.

Conclusions:

• Interpositional fasciocutaneous closure (FTT) is associated with a reduced risk of PCF in salvage laryngectomy settings.
• FTT is the most common technique in academic practices for managing limited pharyngeal defects.
• Closure technique did not influence functional outcomes at 1 and 2 years postoperatively.