PDF(Pubmed)
Abstract：
UNASSIGNED: Closure technique for optimization of postoperative and functional outcomes following salvage laryngectomy remains an area of debate among head and neck surgeons.
UNASSIGNED: To investigate the association of salvage laryngectomy closure technique with early postoperative and functional outcomes.
UNASSIGNED: This retrospective cohort study included patients from 17 academic, tertiary care centers who underwent total laryngectomy with no or limited pharyngectomy after completing a course of definitive radiotherapy or chemoradiotherapy with curative intent between January 2011 and December 2016. Patients with defects not amenable to primary closure were excluded. Data were analyzed from February 14, 2021, to January 29, 2024.
UNASSIGNED: Total laryngectomy with and without limited pharyngectomy, reconstructed by primary mucosal closure (PC), regional closure (RC), or free tissue transfer (FTT).
UNASSIGNED: Patients were stratified on the basis of the pharyngeal closure technique. Perioperative and long-term functional outcomes were evaluated with bivariate analyses. A multivariable regression model adjusted for historical risk factors for pharyngocutaneous fistula (PCF) was used to assess risk associated with closure technique. Relative risks (RRs) with 95% CIs were determined.
UNASSIGNED: The study included 309 patients (256 [82.8%] male; mean age, 64.7 [range, 58.0-72.0] years). Defects were reconstructed as follows: FTT (161 patients [52.1%]), RC (64 [20.7%]), and PC (84 [27.2%]). A PCF was noted in 36 of 161 patients in the FTT group (22.4%), 25 of 64 in the RC group (39.1%), and 29 of 84 in the PC group (34.5%). On multivariable analysis, patients undergoing PC or RC had a higher risk of PCF compared with those undergoing FTT (PC: RR, 2.2 [95% CI, 1.1-4.4]; RC: RR, 2.5 [95% CI, 1.3-4.8]). Undergoing FTT was associated with a clinically meaningful reduction in risk of PCF (RR, 0.6; 95% CI, 0.4-0.9; number needed to treat, 7). Subgroup analysis comparing inset techniques for the RC group showed a higher risk of PCF associated with PC (RR, 1.8; 95% CI, 1.1-3.0) and predominately pectoralis myofascial flap with onlay technique (RR, 1.9; 95% CI, 1.2-3.2), but there was no association of pectoralis myocutaneous flap with cutaneous paddle interposition with PCF (RR, 1.2; 95% CI, 0.5-2.8) compared with FTT with cutaneous inset. There were no clinically significant differences in functional outcomes between the groups.
UNASSIGNED: In this study of patients with limited pharyngeal defects, interpositional fasciocutaneous closure technique was associated with reduced risk of PCF in the salvage setting, which is most commonly achieved by FTT in academic practices. Closure technique was not associated with functional outcomes at 1 and 2 years postoperatively.
UNASSIGNED: To investigate the association of salvage laryngectomy closure technique with early postoperative and functional outcomes.
UNASSIGNED: This retrospective cohort study included patients from 17 academic, tertiary care centers who underwent total laryngectomy with no or limited pharyngectomy after completing a course of definitive radiotherapy or chemoradiotherapy with curative intent between January 2011 and December 2016. Patients with defects not amenable to primary closure were excluded. Data were analyzed from February 14, 2021, to January 29, 2024.
UNASSIGNED: Total laryngectomy with and without limited pharyngectomy, reconstructed by primary mucosal closure (PC), regional closure (RC), or free tissue transfer (FTT).
UNASSIGNED: Patients were stratified on the basis of the pharyngeal closure technique. Perioperative and long-term functional outcomes were evaluated with bivariate analyses. A multivariable regression model adjusted for historical risk factors for pharyngocutaneous fistula (PCF) was used to assess risk associated with closure technique. Relative risks (RRs) with 95% CIs were determined.
UNASSIGNED: The study included 309 patients (256 [82.8%] male; mean age, 64.7 [range, 58.0-72.0] years). Defects were reconstructed as follows: FTT (161 patients [52.1%]), RC (64 [20.7%]), and PC (84 [27.2%]). A PCF was noted in 36 of 161 patients in the FTT group (22.4%), 25 of 64 in the RC group (39.1%), and 29 of 84 in the PC group (34.5%). On multivariable analysis, patients undergoing PC or RC had a higher risk of PCF compared with those undergoing FTT (PC: RR, 2.2 [95% CI, 1.1-4.4]; RC: RR, 2.5 [95% CI, 1.3-4.8]). Undergoing FTT was associated with a clinically meaningful reduction in risk of PCF (RR, 0.6; 95% CI, 0.4-0.9; number needed to treat, 7). Subgroup analysis comparing inset techniques for the RC group showed a higher risk of PCF associated with PC (RR, 1.8; 95% CI, 1.1-3.0) and predominately pectoralis myofascial flap with onlay technique (RR, 1.9; 95% CI, 1.2-3.2), but there was no association of pectoralis myocutaneous flap with cutaneous paddle interposition with PCF (RR, 1.2; 95% CI, 0.5-2.8) compared with FTT with cutaneous inset. There were no clinically significant differences in functional outcomes between the groups.
UNASSIGNED: In this study of patients with limited pharyngeal defects, interpositional fasciocutaneous closure technique was associated with reduced risk of PCF in the salvage setting, which is most commonly achieved by FTT in academic practices. Closure technique was not associated with functional outcomes at 1 and 2 years postoperatively.
摘要：
■在挽救性喉切除术后，用于优化术后和功能结局的闭合技术仍然是头颈部外科医生争论的领域。
■目的探讨挽救性喉切除术闭合技术与术后早期和功能结局的关系。
■这项回顾性队列研究包括来自17名学者的患者，三级护理中心在2011年1月至2016年12月期间完成了一个疗程的确定性放疗或有治愈意向的放化疗后,进行了全喉切除术,没有或有限的咽切除术.不适合初次闭合的缺陷患者被排除在外。数据从2021年2月14日至2024年1月29日进行了分析。
■全喉切除术伴或不伴有限咽切除术，通过原发性粘膜闭合(PC)重建，区域封闭(RC)，或自由组织转移（FTT）。
■根据咽部闭合技术对患者进行分层。通过双变量分析评估围手术期和长期功能结果。针对咽皮瘘（PCF）的历史危险因素进行校正的多变量回归模型用于评估与闭合技术相关的风险。确定95%CI的相对风险(RR)。
■该研究包括309名患者（男性256名[82.8％]；平均年龄，64.7[范围,58.0-72.0]年）。缺损重建如下：FTT（161例患者[52.1％]），RC（64[20.7%]），和PC（84[27.2%]）。FTT组161例患者中有36例出现PCF（22.4%），RC组64人中有25人（39.1%），PC组84人中有29人(34.5%)。在多变量分析中，与接受FTT的患者相比，接受PC或RC的患者发生PCF的风险更高(PC：RR，2.2[95%CI，1.1-4.4]；RC：RR，2.5[95%CI，1.3-4.8]）。接受FTT与临床上有意义的PCF风险降低相关(RR，0.6；95%CI，0.4-0.9；需要治疗的数字，7).比较RC组嵌入技术的亚组分析显示PCF与PC相关的风险较高(RR，1.8；95%CI，1.1-3.0)，主要是胸肌肌筋膜皮瓣，采用高置式技术(RR，1.9；95%CI，1.2-3.2），但胸肌肌皮瓣与皮桨介入PCF无关联(RR，1.2；95%CI，0.5-2.8）与带有皮肤插图的FTT相比。两组之间的功能结局没有临床显着差异。
■在这项对咽部有限缺损患者的研究中，介入式筋膜皮肤闭合技术与抢救环境中PCF风险降低相关，这是FTT在学术实践中最常实现的。闭合技术与术后1年和2年的功能结局无关。
■目的探讨挽救性喉切除术闭合技术与术后早期和功能结局的关系。
■这项回顾性队列研究包括来自17名学者的患者，三级护理中心在2011年1月至2016年12月期间完成了一个疗程的确定性放疗或有治愈意向的放化疗后,进行了全喉切除术,没有或有限的咽切除术.不适合初次闭合的缺陷患者被排除在外。数据从2021年2月14日至2024年1月29日进行了分析。
■全喉切除术伴或不伴有限咽切除术，通过原发性粘膜闭合(PC)重建，区域封闭(RC)，或自由组织转移（FTT）。
■根据咽部闭合技术对患者进行分层。通过双变量分析评估围手术期和长期功能结果。针对咽皮瘘（PCF）的历史危险因素进行校正的多变量回归模型用于评估与闭合技术相关的风险。确定95%CI的相对风险(RR)。
■该研究包括309名患者（男性256名[82.8％]；平均年龄，64.7[范围,58.0-72.0]年）。缺损重建如下：FTT（161例患者[52.1％]），RC（64[20.7%]），和PC（84[27.2%]）。FTT组161例患者中有36例出现PCF（22.4%），RC组64人中有25人（39.1%），PC组84人中有29人(34.5%)。在多变量分析中，与接受FTT的患者相比，接受PC或RC的患者发生PCF的风险更高(PC：RR，2.2[95%CI，1.1-4.4]；RC：RR，2.5[95%CI，1.3-4.8]）。接受FTT与临床上有意义的PCF风险降低相关(RR，0.6；95%CI，0.4-0.9；需要治疗的数字，7).比较RC组嵌入技术的亚组分析显示PCF与PC相关的风险较高(RR，1.8；95%CI，1.1-3.0)，主要是胸肌肌筋膜皮瓣，采用高置式技术(RR，1.9；95%CI，1.2-3.2），但胸肌肌皮瓣与皮桨介入PCF无关联(RR，1.2；95%CI，0.5-2.8）与带有皮肤插图的FTT相比。两组之间的功能结局没有临床显着差异。
■在这项对咽部有限缺损患者的研究中，介入式筋膜皮肤闭合技术与抢救环境中PCF风险降低相关，这是FTT在学术实践中最常实现的。闭合技术与术后1年和2年的功能结局无关。
