Abstract
PurposeSkeletal muscle mass (SMM) loss and sarcopenia have been identified as risk factors for postoperative complications. The aim of this study was to investigate the relationship between pharyngocutaneous fistula (PCF) formation after total laryngectomy (TL) and SMM assessed from a computed tomography image of the 3rd cervical vertebra (C3).MethodsRetrospective study of 86 male patients who underwent TL between 2013 and 2019 in a single institution. We excluded women from the analysis due to our limited sample. SMM was determined from cross-sectional muscle area (CSMA) measurement at C3 using the ImageJ software. Results were compared with those for the skeletal muscle mass index (SMMI) calculated from the estimated measure at 3rd lumbar vertebra (L3).ResultsPCF formation occurred in 21/86 patients. According to the CSMA at a C3 cut-off of 35.5cm2, of 18 patients (20.9%) with low SMM, 9 developed PCFs (50.0%). Among patients with normal SMM (n = 68, 79.1%), 12 developed PCFs (17.6%). The CSMA at C3 was the only variable significantly associated with PCF risk, which was 4.7 times greater in patients with low SMM (p = 0.007). Sarcopenia was more frequent in underweight patients (p = 0.0001), patients undergoing extended surgeries (p = 0.003), or presenting preoperative anaemia (p = 0.009) or hypoalbuminemia (p = 0.027).ConclusionMeasuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL.
Highlights
For some advanced laryngeal and hypopharyngeal tumours, total laryngectomy (TL) is the initial treatment or a salvage treatment after local recurrence
The aim of the present study was to analyse the relationship between low Skeletal muscle mass (SMM), as determined from the cross-sectional muscle area (CSMA) measured directly from a computed tomography (CT) scan slice of C3, and postoperative pharyngocutaneous fistula (PCF) formation in male patients treated with TL
The risk of PCF formation was 4.67 times greater in low SMM patients than in patients with normal SMM
Summary
For some advanced laryngeal and hypopharyngeal tumours, total laryngectomy (TL) is the initial treatment or a salvage treatment after local recurrence. A postoperative complication of TL is the formation of a pharyngocutaneous fistula (PCF). While several observational studies and meta-analyses review predisposing factors for PCF formation [1,2,3,4,5], there is currently no consensus as to which of those factors is the most predictive. In a study performed in our hospital [6], factors identified as being significantly related to PCF formation were the extent of surgery and the presence of postoperative haemoglobin levels below 99 g/L. A growing concern regarding the nutritional status of patients with cancer highlights sarcopenia as a risk factor for treatment-associated complications [7,8,9,10,11,12].
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Schedule a callMore From: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
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