A Systematic Review on Postoperative Complications After Salvage Laryngectomy

Tuesday, October 3, 2023

3:30 PM - 3:36 PM East Coast USA Time

Location: 201AB

Presenting Author(s)

Anyull D. Bohorquez Caballero, MD

Research Trainee
Mayo Clinic in Florida
Jacksonville , FL, United States

Co-Author(s)

NA

Natalia Abadia, MD

Head and neck surgery interest group
Pereira, COL
Estephania Candelo, MD, MSc

Research Fellow
Mayo Clinic Florida
Jacksonville, FL, United States

Senior Author(s)

AR

Adonis T. Ramirez Cuellar, MD

Head and neck surgery interest group
Pereira, COL
PP

Phillip Pirgousis, MD

Otolaryngologist/ Head and Neck surgeon
Mayo Clinic Florida, USA

Disclosure(s):

Anyull D. Bohorquez Caballero, MD: No relevant relationships to disclose.

Introduction: Salvage Total Laryngectomy (STL) is the preferred treatment for laryngeal cancer recurrence after primary surgery, radiotherapy, or radio-chemotherapy. Current evidence mainly focuses on evaluating the efficacy of reconstruction techniques in preventing a pharyngocutaneous fistula (PCF). Nevertheless, PCF is only one of the many complications to be aware of after STL. We aim to update the evidence on postsurgical complications according to the type and subtype of reconstruction used while STL.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this systematic review. A comprehensive search was conducted using PubMed, EMBASE, Science Direct, Scopus, EBSCO, Cochrane Library, and Grey literature from inception to January 2023. A search strategy was based on relevant keywords based on the research question. Only observational studies on laryngeal cancer patients were included. Two independent reviewers performed the titles and abstract screening, full-text review, and data extraction to ensure accuracy. Quality assessment was performed using Newcastle-Ottawa Scale (NOS).

Results: 52 papers including 3630 patients were included. 92.2% of patients underwent STL. 33.8% of procedures were primarily closed and 66.2% underwent flap reconstruction. Flap reconstruction was performed with free and pediculated flaps in 56.7% and 43.3% of the population. The most commonly used flaps were the radial forearm flap and the pectoralis major myofascial flap (40%). 1174 complications were reported. The most commonly reported complications were PCR 70.1%, wound infection 9.7%, and wound dehiscence 8.9%. Overall mortality was 0,7%.

Conclusions: This systematic review provides a comprehensive evaluation of postsurgical complications not previously collected at this level of evidence, while updating the overall incidence of PDF in STL. Despite this, the report of complications other than the presence of CSF is scarce in the current evidence.