Shorter interval between radiation therapy and salvage laryngopharyngeal surgery increases complication rates following microvascular free tissue transfer

• Published in: American journal of otolaryngology 2018-09, Vol.39 (5), p.548-552
• Main Authors: Formeister, Eric J., Sean Alemi, A., El-Sayed, Ivan, George, Jonathan R., Ha, Patrick, Daniel Knott, P., Ryan, William R., Seth, Rahul, Tamplen, Matthew L., Heaton, Chase M.
• Format: Article
• Language: English
• Subjects: Aged; Chemoradiotherapy; Chemoradiotherapy - methods; Cohort Studies; Complications; Dependence; Dissection; Feeding; Female; Fistula; Fistulae; Forearm; Free flap; Free Tissue Flaps - blood supply; Free Tissue Flaps - transplantation; Graft Survival; Hospital costs; Humans; Hypothyroidism; Laryngeal cancer; Laryngeal Neoplasms - mortality; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - radiotherapy; Laryngeal Neoplasms - surgery; Laryngectomy; Laryngectomy - methods; Larynx; Male; Medical personnel; Microvascular reconstruction; Microvasculature; Middle Aged; Multivariate analysis; Nutrition research; Patients; Pharyngectomy - methods; Pharyngocutaneous fistula; Prognosis; Radiation; Radiation therapy; Radiotherapy - methods; Reconstruction; Reconstructive Surgical Procedures - methods; Recovery of Function; Retrospective Studies; Risk Assessment; Salvage; Salvage surgery; Salvage Therapy - methods; Surgery; Surgical outcomes; Survival Rate; Thigh; Time Factors; Treatment Failure; Treatment Outcome
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2018.06.009

To evaluate how the interval between radiation and salvage surgery for advanced laryngeal cancer with free tissue transfer reconstruction influences complication rates. This is a retrospective series of 26 patients who underwent salvage laryngectomy or laryngopharyngectomy with vascularized free tissue reconstruction (anterolateral thigh or radial forearm) following radiation or chemoradiation between 2012 and 2017 at a single academic center. The primary outcome was incidence of postoperative complications, including pharyngocutaneous fistula. Secondary outcomes included the need for a second procedure, time to resumption of oral feeding, feeding tube dependence, and hospital length of stay. Salvage surgery was performed for persistence (7/26, 27%), recurrence/new primary (12/26, 46%), and dysfunctional larynges (7/26, 27%). Twenty-two (85%) defects were reconstructed with an anterolateral thigh free flap and 4/26 with a radial forearm free flap (15%). There were no flap failures. There were significantly more complications in patients undergoing surgery within 12 months of completion of radiation therapy (7/12, 58%) versus those undergoing surgery after 12 months (1/14, 7%; p = .02). Patients experiencing complications more often required a second procedure (4/7 vs. 0/1; p = .02), experienced a longer delay to initiation of oral diet (61 vs. 21 days; p = .04), and stayed in the hospital longer (28 vs. 9 days; p = .01). Shorter intervals between definitive radiation and salvage laryngopharyngeal surgery with free tissue reconstruction increases postoperative complications, hospital length of stay, and the likelihood of feeding tube dependence. Reconstructive surgeons can use these findings to help guide preoperative patient counseling and assess postoperative risk.