Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review.

INTRODUCTION: The most common early postoperative complication after total laryngectomy (TL) is pharyngocutaneous fistula (PCF). Rates of PCF are higher in patients who undergo salvage TL compared with primary TL. Published meta-analyses include heterogeneous studies making the conclusions difficult to interpret. The objectives of this scoping review were to explore the reconstructive techniques potentially available for primary TL and to clarify which could be the best technique for each clinical scenario. METHODS: A list of available reconstructive techniques for primary TL was built and the potential comparisons between techniques were identified. A PubMed literature search was performed from inception to August 2022. Only case-control, comparative cohort, or randomized controlled trial (RCT) studies were included. RESULTS: A meta-analysis of seven original studies showed a PCF risk difference (RD) of 14% (95% CI 8-20%) favoring stapler closure over manual suture. In a meta-analysis of 12 studies, we could not find statistically significant differences in PCF risk between primary vertical suture and T-shaped suture. Evidence for other pharyngeal closure alternatives is scarce. CONCLUSION: We could not identify differences in the rate of PCF between continuous and T-shape suture configuration. Stapler closure seems to be followed by a lower rate of PCF than manual suture in those patients that are good candidates for this technique.

Imaging checklist for preoperative evaluation of laryngeal tumors to be treated by transoral microsurgery: guidelines from the European Laryngological Society.

INTRODUCTION: The modern availability in daily practice of different DICOM viewers allows physicians to routinely evaluate computed tomography (CT) and magnetic resonance (MR) scans of patients in the pre-, intra-, and postoperative settings. Their systematic use, together with a close surgeon-radiologist cooperation, may greatly improve outcomes of patients to be treated by transoral microsurgery for laryngeal cancer. MATERIALS AND METHODS: We herein propose guidelines for systematic evaluation of CT/MR images taken from patients affected by supraglottic and glottic cancer to be treated by transoral microsurgery. RESULTS: A methodical, step-by-step approach focused on laryngeal anatomy, systematically looking at each true and false vocal folds, anterior commissure, laryngeal ventricle, subglottic area, epiglottis, thyroid, cricoid, and arytenoid cartilages, posterior commissure, crico-arytenoid unit, paraglottic and pre-epiglottic spaces, and possible extra-laryngeal extension is proposed. This checklist may be useful before imaging performance (to focus on specific issues to be detailed by the radiologist), as well before and during surgery for the specific evaluation of details to be cleared during transoral microsurgery. CONCLUSION: Detailed preoperative evaluation of supraglottic and glottic anatomy is essential prior to any transoral approach for neoplastic disease. The proposed imaging checklist described herein represents a step-by-step guide to surgeons performing this kind of interventions and an aid in achieving a meticulous approach from a surgical perspective.