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The use of Montgomery salivary bypass tubes and pharyngocutaneous fistula following salvage laryngectomy

World Journal of Otorhinolaryngology-Head and Neck Surgery 2024年第1期10卷 43-48页

作者： Courtney B.Shires Mackenzie Latour Merry Sebelik Karuna Dewan West Cancer Center GermantownTennesseeUSA Department of Otolaryngology-Head and Neck Surgery Louisiana State University Health ShreveportShreveportLouisianaUSA Department of Otolaryngology-Head and Neck Surgery Emory UniversityAtlantaGeorgiaUSA

Objectives:Pharyngocutaneous fistula(PCF)is the most common complication to follow total laryngectomy(TL)and is associated with increases in length of hospital stay and with a need for revision surgery or readmission,as well as with delays in return to oral diet.Patients who require salvageTL(STL)or primary(chemo)radiation therapy are at higher risk for developing PCF.Due to the quality‐of‐life burden of PCF on patients,limiting this occurrence is crucial.Methods:We conducted a retrospective cohort study of patients undergoing STL with placement of Montgomery salivary bypass tube(MSBT)^(TM)for at least 2 weeks duration between 2013 and 2017 at a single institution.Our patients all underwent free flap reconstruction.Our primary outcome of interest was development of PCF.Secondary outcomes included demographics,previous treatment,base of tongue(BOT)involvement,extent of defect,concurrent neck dissection(ND),and margin status.Univariateχ^(2) analysis was used to evaluate factors associated with PCF.Results:Forty‐four patients underwent STL with Montgomery tube placement and free flap reconstruction.Eight developed PCF(18.2%).The average age was 61.6 years;36 patients were male(81.8%),whereas eight patients were female(18.2%).There was no association between PCF and previous chemoradiation versus radiation(15.8%vs.33.3%,P<0.30),BOT involvement versus not(11.1 vs.22.2%,P<0.38),circumferential versus partial defect(18.8%vs.17.9%,P<0.94),ND versus none(10%vs.25%,P<0.20),or margin status.Conclusion:PCF complicated 18.2%of STL cases at our institution and was not associated with differences in primary treatment modality,presence of concomitant ND,extent of pharyngeal defect,BOT involvement,or positive frozen or permanent surgical margin.

关键词： free flap reconstruction Montgomery pharyngocutaneous fistula salivary bypass tube salvage total laryngectomy total laryngectomy

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Linear Stapler in total laryngectomy

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International Journal of Otolaryngology and Head & Neck Surgery 2014年第6期3卷 354-358页

作者： Carolina Durao Sofia Decq Motta Ana Hebe Ricardo Pacheco Pedro Montalvao Miguel Magalhaes Otolaryngology Department Hospital Prof.Doutor Fernando FonsecaAmadoraPortugal Otolaryngology Department Portuguese Oncology Institute of LisbonFrancisco GentilPortugal

Introduction: Stapler application for pharyngeal closure after total laryngectomy allows rapid watertight closure. We intend to report the experience of the Portuguese Oncology Institute of Lisbon, Francisco Gentil (IPOLFG). Material and Methods: Retrospective study of patients submitted to total laryngectomy using linear stapler device treated in IPOLFG from 2005 to 2010. Results: 108 patients were studied. The majority of patients were male, aged from 60 to 69 years old, and had smoking and alcohol habits. The average length of hospital stay was 13.1 days. Post-operative complications occurred as follows: wound infection in 6.5%, cervical hematoma in 4.6% and pharyngocutaneous fistula in 11.1% of cases. Conclusions: The mechanical suture of the pharynx in total laryngectomy is a simple and quick method. It does not increase the incidence of post-operative complications. It seems to be a very safe method, as long as its limits regarding the location and extent of tumour are respected.

关键词： Pharyngeal Closure total laryngectomy Linear Stapler

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Neck dissection does not add to morbidity or mortality of laryngectomy

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2019年第4期5卷 215-221页

作者： Christopher C.Xiao Sarah A.Imam Shaun A.Nguyen Marc P.Camilon Andrew B.Baker Terry A.Day Eric J.Lentsch Department of Otolaryngology-Head and Neck Surgery Kaiser PermanenteNorthern CaliforniaOaklandCA94612USA Department of Health and Human Performance The CitadelCharlestonSC29409USA Department of Otolaryngology-Head and Neck Surgery Medical University of South CarolinaCharlestonSC29425USA Oregon Health&Science University Ear Nose&ThroatPortlandOR97239USA

Objectives:To examine the national rates of complications,readmission,reoperation,death and length of hospital stay after laryngectomy.To explore the risks of neck dissection with laryngectomy using outcomes.Methods:The American College of Surgeons National Quality Improvement Program(ACS-NSQIP)database was reviewed retrospectively.The database was analyzed for patients undergoing laryngectomy with and without neck dissection.Demographic,perioperative complication,reoperation,readmission,and death variables were analyzed.Results:754 patients who underwent total laryngectomy during this time were found.Demographic analysis showed average age was 63 years old,566(75.1%)were white,and 598(79.3%)were male.Of these patients,520(69.0%)included a neck dissection while 234(31.0%)did not.When comparing patients who received a neck dissection to those who did not,there were no significant differences in median length of hospital stay(12.5 days w/vs.13.3 days w/o,P=0.99),rates of complication(40%w/vs.35%w/o,P=0.23),reoperation(13.5%w/vs.14%w/o,P=0.81),readmission(14%w/vs.18%w/o,P=0.27),and death(1.3%w/vs.1.3%w/o,P>0.99).Furthermore,neck dissection did not increase the risk of complication(P=0.23),readmission(P=0.27),reoperation(P=0.81),death(P=0.94),or lengthened hospital stay(P=0.38).Conclusions:Concurrent neck dissection does not increase postoperative morbidity or mortality in patients undergoing total laryngectomies.These results may help physicians make decisions regarding concurrent neck dissection with total laryngectomy.

关键词： laryngectomy Neck dissection total laryngectomy Complication rates Outcomes

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Tracheoesophageal Voice Prosthesis Outcomes:Success or Insucess?

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International Journal of Otolaryngology and Head & Neck Surgery 2014年第1期3卷 14-22页

作者： Sara Cruz Rita Viana Joana Guimaraes Joao Fernandes Joaquim Castro Silva Eurico Monteiro Servico de Otorrinolaringologia Instituto Portugues de Oncologia Francisco Gentil do PortoPortoPortugal

Introduction: total laryngectomy/pharingo-laryngectomy is a potentially aggressive surgery for advanced laryngeal/hypopharyngeal carcinomas, which results in important physical and functional changes that compromise some of the most vital functions, including speech communication. For these patients, tracheoesophageal speech is considered to be the gold standard for voice rehabilitation. Objectives: The purpose of the present study was to determinate the success rate of voice prosthesis rehabilitation, voice prosthesis lifetime and the rate of complications, and its related clinicopathologic factors. Material and Methods: Retrospective review of 92 patients who undergone tracheoesophageal puncture (TEP) performed between January 2007 and December 2012 at the Francisco Gentil Portuguese Institute of Oncology of Oporto. Age, primary disease, staging, the extent of surgical resection, radiotherapy treatment, timing of TEP, surgical and prosthesis-related complications were noted. The impact of these clinicpathological factors on functional outcome, complications of TEP and lifetime of prosthetic valves was assessed in univariate analysis. Vocal rehabilitation efficacy with voice prosthesis was assessed with the multidimensional Harrison-Robillard Shultz (HRS) Rating Scale. Lifetime of voice prosthesis and early and late complications were recorded. Results: A total of 83 patients met the study criteria, predominantly males (94%) with a mean age of 63.7 years. 77% of the patients underwent primary and 23% secondary TEP. 68.7% of patients achieved functional tracheoesophageal speech (HRS score ≥ 10), 67.2% had performed primary TEP and 73.7% had performed secondary TEP. The mean device lifetime was 9.8 months for voice prosthesis. Prosthesis-related complications occurred in 81% of the patients and the most common issues were prosthesis leakage (76%) and displacement (22%). The most common surgical-related problem was a large and deep tracheostoma. Conclusions: Our success rate of voice rehabilitation was comparable t

关键词： Laryngeal Cancer total laryngectomy Tracheoesophageal Puncture Tracheoesophageal Speech Voice Prosthesis

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Comparison of the clinical outcomes of early enteral nutrition and a convenience diet by tube feeding following laryngectomy in China

Comparison of the clinical outcomes of early enteral nutriti...

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第十二届全国营养科学大会

作者：郭静重庆市第三军医大学大坪医院

目的 The purpose of this study was to evaluate the efficiency of early enteral nutritional support in patients undergoing laryngectomy.方法 We retrospectively reviewed 329 laryngeal cancer patients who underwent total or partial laryngectomy from November 2003 to July 2013 at our institution.Of these patients,278 were given enteral nutrition(EN group)with commercial formulations through a nasogastric tube after the surgery,while 51 patients chose to receive a homogenate convenience diet(CD group).The clinical outcomes were compared between the two groups.结果 Thirteen patients(13/278,4.68%)in the EN group and six patients(6/51,11.76%)in the CD group developed fistulas.The difference was statistically significant(plaryngectomy by providing early enteral nutrition.

关键词： total laryngectomy Partial laryngectomy Enteral Nutrition Pharyngocutaneous

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