背景:全喉切除术(TL)是一种通常对晚期喉癌或下咽癌患者进行的外科手术。TL术后最常见的并发症之一是咽部皮肤瘘(PCF)的发展,其特征在于新咽和皮肤之间的交流。PCF会导致住院时间延长,延迟口服喂养,生活质量受损。在咽部闭合过程中使用肌筋膜胸大肌皮瓣(PMMF)作为高置式技术已显示出降低发生PCF的高风险患者的PCF发生率的潜力,例如放化疗后接受TL和低骨骼肌质量(SMM)的患者。它对各种功能结果的影响,如肩部和颈部功能,吞咽功能,和语音质量,探索较少。本研究旨在探讨PMMF在降低低SMM患者PCF发生率方面的有效性及其对患者健康的潜在影响。
方法:这项多中心研究采用随机临床试验(RCT)设计,由荷兰癌症协会资助。符合TL标准的患者,年龄≥18岁,精神上有能力,精通荷兰语,将被注册。128名SMM低的患者将被集中随机分配接受有或没有PMMF的TL,而那些没有低SMM将接受标准TL。主要结果测量包括评估TL后30天内的PCF率。次要目标包括评估生活质量,肩颈功能,吞咽功能,和语音质量使用标准化问卷和功能测试。数据将通过电子病历收集。
结论:这项研究的意义在于探索在咽部闭合过程中使用PMMF作为一种嵌入技术来降低低SMM的TL患者的PCF发生率的潜在益处。通过评估各种功能结果,该研究旨在全面了解PMMF部署的影响。预期的结果将有助于优化手术技术以提高患者预后并为TL患者提供未来治疗策略的宝贵见解。
背景:NL8605,于2020年5月11日注册;国际临床试验注册平台(ICTRP)。
BACKGROUND: Total laryngectomy (TL) is a surgical procedure commonly performed on patients with advanced laryngeal or hypopharyngeal carcinoma. One of the most common postoperative complications following TL is the development of a pharyngocutaneous fistula (PCF), characterized by a communication between the neopharynx and the skin. PCF can lead to extended hospital stays, delayed oral feeding, and compromised quality of life. The use of a myofascial pectoralis major flap (PMMF) as an onlay technique during pharyngeal closure has shown potential in reducing PCF rates in high risk patients for development of PCF such as patients undergoing TL after chemoradiation and low skeletal muscle mass (SMM). Its impact on various functional outcomes, such as shoulder and neck function, swallowing function, and voice quality, remains less explored. This
study aims to investigate the effectiveness of PMMF in reducing PCF rates in patients with low SMM and its potential consequences on patient well-being.
METHODS: This multicenter
study adopts a randomized clinical
trial (RCT) design and is funded by the Dutch Cancer Society. Eligible patients for TL, aged ≥ 18 years, mentally competent, and proficient in Dutch, will be enrolled. One hundred and twenty eight patients with low SMM will be centrally randomized to receive TL with or without PMMF, while those without low SMM will undergo standard TL. Primary outcome measurement involves assessing PCF rates within 30 days post-TL. Secondary objectives include evaluating quality of life, shoulder and neck function, swallowing function, and voice quality using standardized questionnaires and functional tests. Data will be collected through electronic patient records.
CONCLUSIONS: This
study\'s significance lies in its exploration of the potential benefits of using PMMF as an onlay technique during pharyngeal closure to reduce PCF rates in TL patients with low SMM. By assessing various functional outcomes, the
study aims to provide a comprehensive understanding of the impact of PMMF deployment. The anticipated results will contribute valuable insights into optimizing surgical techniques to enhance patient outcomes and inform future treatment strategies for TL patients.
BACKGROUND: NL8605, registered on 11-05-2020; International Clinical Trials Registry Platform (ICTRP).