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- Title
Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis.
- Authors
Tonsbeek, Anthony M.; Leidelmeijer, Roxy; Hundepool, Caroline A.; Duraku, Liron S.; Van der Oest, Mark J. W.; Sewnaik, Aniel; Mureau, Marc A. M.
- Abstract
Simple Summary: Although several techniques exist for reconstructing partial hypopharyngeal defects following a total laryngectomy, no international consensus has been reached to date. As a result, there currently are large differences between institutions with regard to the flap types used to perform these reconstructions. The aim of this systematic review and meta-analysis was to examine the complication rates and functional results of commonly used reconstructive techniques for hypopharyngeal defects. Pectoralis major myofascial flaps showed promising results compared to free-flap reconstructions, with similar rates of fistulas, strictures and flap failure. In contrast, pectoralis major myocutaneous flaps had a significantly higher fistula rate (34%) in comparison to other flap types (range: 7–17%), whereas no differences were observed for strictures, flap failure or oral intake. Free flaps and pectoralis major myofascial flaps should be considered the preferred methods for the reconstruction of partial hypopharyngeal defects following total laryngectomy. Background: Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. Methods: A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. Results: Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23–47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. Conclusion: Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.
- Subjects
SPEECH evaluation; FISTULA; RESEARCH funding; FUNCTIONAL assessment; STENOSIS; PECTORALIS muscle; META-analysis; SURGICAL complications; SURGICAL flaps; SYSTEMATIC reviews; LARYNGECTOMY; THIGH; PLASTIC surgery; DEGLUTITION; CONFIDENCE intervals; HYPOPHARYNX; FOREARM
- Publication
Cancers, 2024, Vol 16, Issue 10, p1804
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16101804