Our Summary

The research paper is about a study that looked at the development of a complication called pharyngocutaneous fistula (PCF) after a specific type of throat surgery called salvage total laryngectomy (STL). This complication is an abnormal connection between the throat and skin. The researchers compared two methods used to rebuild the throat area after surgery: one using a piece of the chest muscle (pectoralis major) laid flat (onlay) and the other inserting the same muscle in between other tissues (interposition).

The study included information from 24 articles that altogether involved 1304 patients. The findings showed that using the flat-lying muscle method decreases the chances of developing both minor and major PCF. However, the method of inserting the muscle in between other tissues increased the chances of developing PCF compared to the flat-lying muscle method. They didn’t have enough data to compare the muscle insertion method with the standard way of closing the throat after surgery.

In simple terms, if you’re having this specific type of throat surgery, using a piece of your chest muscle to rebuild the area and laying it flat seems to reduce the chances of developing an unpleasant complication.

FAQs

  1. What is pharyngocutaneous fistula (PCF) and how is it related to salvage total laryngectomy (STL)?
  2. What are the two methods used to rebuild the throat area after STL and how do they compare in terms of PCF development?
  3. Does the use of the chest muscle (pectoralis major) in the throat reconstruction process impact the likelihood of developing PCF after STL?

Doctor’s Tip

So, a helpful tip a doctor might tell a patient about laryngectomy is to discuss with your surgeon the option of using the flat-lying muscle method for reconstruction after surgery to potentially lower the risk of developing a pharyngocutaneous fistula. It’s important to have open communication with your healthcare team to ensure the best possible outcome for your recovery.

Suitable For

Patients who are recommended laryngectomy are typically those with advanced stage laryngeal cancer that has not responded to other treatments such as radiation therapy or chemotherapy. Laryngectomy may also be recommended for patients with recurrent laryngeal cancer or for those who are unable to undergo other treatments due to medical reasons.

Timeline

  • Before laryngectomy:
  1. Patient is diagnosed with a condition that requires laryngectomy, such as laryngeal cancer.
  2. Patient undergoes preoperative testing and consultations to prepare for surgery.
  3. Patient undergoes laryngectomy surgery, which involves removing the larynx (voice box).
  4. After surgery, patient may experience pain, swelling, and difficulty speaking or swallowing.
  • After laryngectomy:
  1. Patient undergoes rehabilitation to learn how to speak using alternative methods such as a tracheoesophageal puncture (TEP) or a voice prosthesis.
  2. Patient may experience changes in their ability to taste, smell, and breathe due to the surgery.
  3. Patient may require additional surgeries or procedures to address complications or improve function.
  4. Patient may need ongoing support and counseling to adjust to life without a larynx.
  5. Patient may experience long-term effects such as changes in voice quality, increased risk of pneumonia, and psychological challenges related to communication and body image.

What to Ask Your Doctor

  1. What is a pharyngocutaneous fistula (PCF) and how common is it after laryngectomy surgery?
  2. What are the risk factors for developing PCF after laryngectomy surgery?
  3. What are the differences between using the flat-lying muscle method and the muscle insertion method for rebuilding the throat area after surgery?
  4. What are the potential benefits of using the flat-lying muscle method in reducing the chances of developing PCF?
  5. Are there any potential drawbacks or risks associated with using the flat-lying muscle method compared to the muscle insertion method?
  6. How will the choice of reconstruction method affect my recovery and long-term outcomes after laryngectomy surgery?
  7. Are there any other factors or considerations I should take into account when deciding on the reconstruction method for my surgery?
  8. What is the success rate of using the flat-lying muscle method compared to the muscle insertion method in preventing PCF?
  9. How will the choice of reconstruction method affect my quality of life and ability to speak and swallow after surgery?
  10. Are there any alternative methods or techniques available for reducing the risk of developing PCF after laryngectomy surgery?

Reference

Authors: Cabrera CI, Joseph Jones A, Philleo Parker N, Emily Lynn Blevins A, Weidenbecher MS. Journal: Otolaryngol Head Neck Surg. 2021 May;164(5):972-983. doi: 10.1177/0194599820957962. Epub 2020 Sep 29. PMID: 32988281