Abstract：
OBJECTIVE: Salvage laryngectomy is more predisposed to complications than primary operations, with pharyngocutaneous fistula (PCF) being among the most challenging to manage. Vascularized flaps are increasingly employed during salvage laryngectomy, with a previous review finding a PCF incidence of 31.2% and 22.2% after primary and flap-assisted closure respectively. We aim to better define the role of vascularized flaps after salvage laryngectomy by performing an updated review comparing the rate of PCF in those undergoing primary or vascularized flap-assisted closure.
METHODS: Pubmed/Medline, CINAHL, and CENTRAL.
METHODS: An updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta-analysis of odds ratios (OR) and pooled proportions were conducted.
RESULTS: Literature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I2 = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I2 = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I2 = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I2 = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on-lay and patch closure compared to primary closure techniques. Network meta-analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure.
CONCLUSIONS: The updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap-assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 134:2991-3002, 2024.
METHODS: Pubmed/Medline, CINAHL, and CENTRAL.
METHODS: An updated literature review was conducted of English language literature from 2003 to 2023. A random effects and network meta-analysis of odds ratios (OR) and pooled proportions were conducted.
RESULTS: Literature search found 31 studies, including seven from the previous review. Overall random effects pooled PCF rate was 25% (95% CI 0.21; 0.30, I2 = 72%, p = <0.01), whereas incidence in primary closure was 37% (95% CI 0.32; 0.43, I2 = 60%, p = <0.01) and 19% (95% CI 0.12; 0.20, I2 = 47%, p = <0.01) after flap closure. Pooled OR was 0.39 (95% CI 0.28; 0.55, I2 = 36%, p = 0.04) in favor of vascularized tissues. The number needed to treat was 6.5. The rate of PCF was lower after free and pedicled flaps, and on-lay and patch closure compared to primary closure techniques. Network meta-analysis found all combinations of closure techniques and vascularized tissue were superior to primary closure.
CONCLUSIONS: The updated analysis has demonstrated a widening in the rates of PCF between primary and vascularized flap-assisted closure. Surgeons should strongly consider the use of free or pedicled flaps in any salvage laryngectomy procedure. Laryngoscope, 134:2991-3002, 2024.
摘要：
目的：挽救性喉切除术比初次手术更容易发生并发症，咽部皮肤瘘（PCF）是最具挑战性的治疗方法之一。血管化皮瓣在挽救性喉切除术中越来越多地使用，先前的评论发现，初次和皮瓣辅助闭合后PCF的发生率分别为31.2％和22.2％。我们的目标是通过进行更新的审查，比较接受原发性或血管化皮瓣辅助闭合的患者中PCF的发生率，从而更好地定义挽救性喉切除术后血管化皮瓣的作用。
方法：Pubmed/Medline，CINAHL,中央。
方法：对2003年至2023年的英语语言文学进行了最新的文献综述。对比值比（OR）和合并比例进行随机效应和网络荟萃分析。
结果：文献检索发现31项研究，包括先前审查的七个。总体随机效应合并PCF率为25%(95%CI0.21;0.30,I2=72%,p=<0.01)，而初次闭合的发生率为37%(95%CI0.32;0.43,I2=60%,p=<0.01)和19%(95%CI0.12；0.20，I2=47%，p=<0.01）皮瓣闭合后。合并OR为0.39(95%CI0.28；0.55，I2=36%，p=0.04）有利于血管化组织。需要治疗的人数为6.5。游离皮瓣和带蒂皮瓣后PCF的发生率较低，以及与主要闭合技术相比的铺设和贴片闭合。网络荟萃分析发现，所有闭合技术和血管化组织的组合均优于初次闭合。
结论：更新的分析表明，原发性和血管化皮瓣辅助闭合之间PCF的发生率增加。在任何挽救性喉切除术中，外科医生应强烈考虑使用游离或带蒂皮瓣。喉镜,2024.
方法：Pubmed/Medline，CINAHL,中央。
方法：对2003年至2023年的英语语言文学进行了最新的文献综述。对比值比（OR）和合并比例进行随机效应和网络荟萃分析。
结果：文献检索发现31项研究，包括先前审查的七个。总体随机效应合并PCF率为25%(95%CI0.21;0.30,I2=72%,p=<0.01)，而初次闭合的发生率为37%(95%CI0.32;0.43,I2=60%,p=<0.01)和19%(95%CI0.12；0.20，I2=47%，p=<0.01）皮瓣闭合后。合并OR为0.39(95%CI0.28；0.55，I2=36%，p=0.04）有利于血管化组织。需要治疗的人数为6.5。游离皮瓣和带蒂皮瓣后PCF的发生率较低，以及与主要闭合技术相比的铺设和贴片闭合。网络荟萃分析发现，所有闭合技术和血管化组织的组合均优于初次闭合。
结论：更新的分析表明，原发性和血管化皮瓣辅助闭合之间PCF的发生率增加。在任何挽救性喉切除术中，外科医生应强烈考虑使用游离或带蒂皮瓣。喉镜,2024.
