Prevention of Pharyngocutaneous Fistula After Total Laryngectomy by Otolaryngologists and Multidisciplinary Team Efforts Against Adverse Events of Chemoradiotherapy

Abstract

The standard treatment for advanced laryngeal cancer is total laryngectomy and chemoradiotherapy, but measures against adverse events vary. Complications such as pharyngocutaneous fistula after total laryngectomy can be prevented to some extent by the preoperative and intraoperative efforts of the otolaryngologist, and it is necessary to improve the skills of surgical techniques. The incidence of pharyngocutaneous fistulas at our facility was 20.3% (53/261) over 20 years, with a significant reduction in fistula incidence from 31.5% in the first decade to 10.2% in the second decade (p=0.000024). Preventive measures against pharyngocutaneous fistulas include appropriately trimming the margins of the pharyngeal mucosa with an impaired blood flow, making drugs with antibacterial activity against oral anaerobic bacteria the first choice as a prophylactic antibacterial drug, and performing pharyngeal closure using the Gambee stitching method. Thanks to these efforts, other than salvage surgery after chemoradiotherapy, only 2 out of 34 cases developed pharyngocutaneous fistulas, both of which were cured by conservative treatment; however, in salvage surgery after chemoradiotherapy, pharyngocutaneous fistulas were seen in 3 out of 10 patients, all of which required surgical treatment. Regarding adverse events of chemoradiotherapy, multidisciplinary supportive care is essential, and otolaryngologists are required to take on a leadership role in organizing teams capable of performing specific interventions.