Lemaire, Emilien and Schultz, Philippe and Vergez, Sébastien and Debry, Christian and Sarini, Jérome and Vairel, Benjamin and de Bonnecaze, Guillaume and Takeda-Raguin, Catherine and Cabarrou, Bastien and Dupret Bories, Agnès
Risk Factors for Pharyngocutaneous Fistula After Total Pharyngolaryngectomy.
(2020)
Ear, Nose & Throat Journal, 1 (7). 014556131990103. ISSN 0145-5613
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(Document in English)
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Official URL: https://doi.org/10.1177/0145561319901035
Abstract
Purpose:To evaluate the risk factors of pharyngocutaneous fistula after total pharyngolaryngectomy (TPL) in orderto reduce theirincidence and propose a perioperative rehabilitation protocol.Materials and Methods:This was a multicenter retrospectivestudy based on 456 patients operated for squamous cell carcinoma by total laryngectomy or TPL. Sociodemographic, medical,surgical, carcinologic, and biological risk factors were studied. Reactive C protein was evaluated on post-op day 5. Patients weredivided into a learning population and a validation population with patients who underwent surgery between 2006 and 2013 andbetween 2014 and 2016, respectively. A risk score of occurrence of salivary fistula was developed from the learning population dataand then applied on the validation population (temporal validation).Objective:To use a preoperative risk score in order tomodify practices and reduce the incidence of pharyngocutaneous fistula.Results:Four hundred fifty-six patients were included,328 in the learning population and 128 in the validation population. The combination of active smoking over 20 pack-years, ahistory of cervical radiotherapy, mucosal closure in separate stitches instead of running sutures, and the placement of a pedicleflap instead of a free flap led to a maximum risk of post-op pharyngocutaneous fistula after TPL. The risk score was discriminantwith an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI]¼0.59-0.73) and 0.70 (95% CI¼0.60-0.81) for the learning population and the validation population, respectively.Conclusion:A preoperative risk score couldbe used to reduce the rate of pharyngocutaneous fistula after TPL by removing 1 or more of the 4 identified risk factors.
Item Type: | Article |
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Additional Information: | Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License |
HAL Id: | hal-03203360 |
Audience (journal): | International peer-reviewed journal |
Uncontrolled Keywords: | |
Institution: | Other partners > Centre Hospitalier Universitaire de Strasbourg - CHU Strasbourg (FRANCE) Other partners > Institut Claudius Regaud - ICR (FRANCE) Other partners > Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE) |
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Deposited On: | 20 Apr 2021 15:36 |
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