Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review
Pharyngocutaneous fistula (PCF) remains one of the most frequent and serious complications following total laryngectomy (TL). PCF can lead to severe health issues such as infections and thromboembolic events prolonging hospitalization, as well as to life-threatening large neck vessels blowout and me...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1597538/full |
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| author | Cesare Piazza Cesare Piazza Claudia Montenegro Vincent Vander Poorten Vincent Vander Poorten |
| author_facet | Cesare Piazza Cesare Piazza Claudia Montenegro Vincent Vander Poorten Vincent Vander Poorten |
| author_sort | Cesare Piazza |
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| description | Pharyngocutaneous fistula (PCF) remains one of the most frequent and serious complications following total laryngectomy (TL). PCF can lead to severe health issues such as infections and thromboembolic events prolonging hospitalization, as well as to life-threatening large neck vessels blowout and mediastinitis. Despite technical advancements, PCF rate after TL remains around 10%, underlining its challenges in terms of prevention and management. Numerous studies have identified risk factors contributing to PCF development: they can be distinguished into patient-, tumor-, and surgical technique related variables. Nevertheless, a wide consensus has yet to be reached for most of them. Two of the most encountered and recognized risk factors are certainly represented by salvage setting after failure of (C)RT and extension of TL to oro-, hypopharynx or cervical esophagus. In the first scenario, the use of both pedicled and free flaps either with an onlay or an inlay technique have been described, while in case of extended TL, general consensus has been reached in favor of inlay free flaps. Simultaneous use of salivary bypass tube is another commonly applied tool for PCF prevention. This review aims to describe current strategies for prevention and management of PCF after primary and salvage TL with possible extension to adjacent sites. |
| format | Article |
| id | doaj-art-71835eac9b794117b09b7feaf5e26efd |
| institution | OA Journals |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-71835eac9b794117b09b7feaf5e26efd2025-08-20T02:33:18ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-05-011510.3389/fonc.2025.15975381597538Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative reviewCesare Piazza0Cesare Piazza1Claudia Montenegro2Vincent Vander Poorten3Vincent Vander Poorten4Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, ItalyDepartment of Surgical and Medical Specialties, Radiological Sciences, and Public Health (DSMC), University of Brescia, School of Medicine, Brescia, ItalyUnit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, ItalyDepartment of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, BelgiumOtorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, BelgiumPharyngocutaneous fistula (PCF) remains one of the most frequent and serious complications following total laryngectomy (TL). PCF can lead to severe health issues such as infections and thromboembolic events prolonging hospitalization, as well as to life-threatening large neck vessels blowout and mediastinitis. Despite technical advancements, PCF rate after TL remains around 10%, underlining its challenges in terms of prevention and management. Numerous studies have identified risk factors contributing to PCF development: they can be distinguished into patient-, tumor-, and surgical technique related variables. Nevertheless, a wide consensus has yet to be reached for most of them. Two of the most encountered and recognized risk factors are certainly represented by salvage setting after failure of (C)RT and extension of TL to oro-, hypopharynx or cervical esophagus. In the first scenario, the use of both pedicled and free flaps either with an onlay or an inlay technique have been described, while in case of extended TL, general consensus has been reached in favor of inlay free flaps. Simultaneous use of salivary bypass tube is another commonly applied tool for PCF prevention. This review aims to describe current strategies for prevention and management of PCF after primary and salvage TL with possible extension to adjacent sites.https://www.frontiersin.org/articles/10.3389/fonc.2025.1597538/fullpharyngocutaneous fistulapreventionmanagementtotal laryngectomysalvage settingfree flap |
| spellingShingle | Cesare Piazza Cesare Piazza Claudia Montenegro Vincent Vander Poorten Vincent Vander Poorten Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review Frontiers in Oncology pharyngocutaneous fistula prevention management total laryngectomy salvage setting free flap |
| title | Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review |
| title_full | Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review |
| title_fullStr | Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review |
| title_full_unstemmed | Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review |
| title_short | Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review |
| title_sort | preventing and managing pharyngocutaneous fistula after total laryngectomy a narrative review |
| topic | pharyngocutaneous fistula prevention management total laryngectomy salvage setting free flap |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1597538/full |
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