Our Summary

This study looked at the best ways to prevent a complication called pharyngocutaneous fistula (PCF), which can occur after a specific type of throat surgery called salvage total laryngectomy (STL). The researchers analyzed data from 1694 patients and found that using a specific technique - overlaying a tissue graft (called a pedicled flap onlay or PFO) - significantly reduced the chances of PCF compared to just stitching the throat up normally. In fact, the PFO technique had a 39.9% chance of being the most effective method to prevent PCF. In simpler terms, if you’re having this type of throat surgery, using a tissue graft could reduce the risk of complications.

FAQs

  1. What is a pharyngocutaneous fistula (PCF)?
  2. What is the pedicled flap onlay (PFO) technique?
  3. How does the PFO technique compared to normal stitching in preventing PCF after a salvage total laryngectomy?

Doctor’s Tip

Another helpful tip a doctor might tell a patient about laryngectomy is to practice good swallowing techniques to prevent aspiration (when food or liquid enters the lungs instead of the stomach). This can include taking smaller bites, chewing food thoroughly, and sitting upright while eating. Additionally, staying hydrated and avoiding foods that are difficult to swallow can also help prevent complications post-surgery.

Suitable For

Patients who are recommended for laryngectomy are typically those who have been diagnosed with advanced stage laryngeal cancer that has not responded to other treatments such as radiation or chemotherapy. Additionally, patients with recurrent laryngeal cancer or those who have severe breathing or swallowing difficulties may also be recommended for laryngectomy.

Timeline

Before laryngectomy:

  • Patient undergoes various tests and consultations to determine if laryngectomy is necessary
  • Patient may undergo radiation or chemotherapy treatment prior to surgery
  • Patient receives pre-operative instructions and prepares for the surgery

After laryngectomy:

  • Patient wakes up with a tracheostomy tube to help with breathing
  • Patient may experience pain, discomfort, and difficulty swallowing
  • Patient undergoes speech therapy to learn new ways of communicating
  • Patient may need nutritional support through a feeding tube
  • Patient learns how to care for the stoma and tracheostomy tube
  • Patient may experience emotional and psychological challenges adjusting to the changes in their voice and appearance

Overall, the process before and after laryngectomy involves thorough preparation, surgical intervention, and comprehensive rehabilitation to help the patient adjust to the new changes in their life.

What to Ask Your Doctor

  1. What is a laryngectomy and why do I need one?
  2. What are the potential complications of a laryngectomy, specifically pharyngocutaneous fistula (PCF)?
  3. What techniques will be used during the surgery to reduce the risk of PCF?
  4. What is the success rate of using a tissue graft (PFO) to prevent PCF compared to other methods?
  5. What is the recovery process like after a laryngectomy and how long will it take?
  6. What can I expect in terms of speech and swallowing function after the surgery?
  7. What are the potential long-term effects of a laryngectomy on my overall health?
  8. Are there any lifestyle changes or modifications I will need to make after the surgery?
  9. Are there any support groups or resources available for laryngectomy patients?
  10. What is the follow-up care plan after the surgery and how often will I need to see my doctor for monitoring?

Reference

Authors: De Virgilio A, Costantino A, Festa BM, Russo E, Malvezzi L, Pellini R, Colombo G, Spriano G, Mercante G, Ferreli F. Journal: Eur Arch Otorhinolaryngol. 2022 Dec;279(12):5839-5849. doi: 10.1007/s00405-022-07490-9. Epub 2022 Jun 22. PMID: 35731297