Okamoto Isaku, Tsukahara Kiyoaki, Shimizu Akira, Sato Hiroki
a Department of Otolaryngology, Head and Neck Surgery , Tokyo Medical University , Shinjuku-ku , Tokyo , Japan.
Acta Otolaryngol. 2019 Feb;139(2):167-171. doi: 10.1080/00016489.2018.1532108. Epub 2019 Feb 22.
Salvage surgery for laryngeal cancer recurring after radiotherapy is difficult and complications readily occur. Our institution has adopted the pharyngeal interposition graft (PIG) using a pectoralis major myocutaneous (PMMC) flap, which has copious blood flow, for preventing post-irradiation pharyngocutaneous fistula.
AIMS/OBJECTIVES: The purpose of this study was to examine the incidence of post-operative complications of salvage total laryngectomy (STL) using the PMMC flap for post-radiotherapy recurrent laryngeal cancer at our institution.
From among 162 patients with laryngeal cancer who had been treated at Tokyo Medical University Hospital between January 2014 and March 2018, we enrolled 11 patients who had undergone STL applying a PMMC flap. We examined patient backgrounds (age, gender, subtype, stage), initial therapy (radiotherapy/chemoradiotherapy), radiation dose, irradiation area, surgery type (with/without neck dissection) and postoperative complications.
No severe systemic complications were encountered. Pharyngocutaneous fistula occurred as a severe local complication in one patient (8.3%) and wound infection as a mild local complication in one patient (8.3%).
Rates of post-operative complications following STL tended to be lower at our institution than those reported for other institutions.
PIG may be a useful surgical procedure in STL.
喉癌放疗后复发进行挽救性手术困难且并发症易发生。本院采用带蒂胸大肌肌皮瓣（PMMC瓣）的咽内置入移植术（PIG），该肌皮瓣血运丰富，用于预防放疗后咽皮肤瘘。
本研究旨在探讨本院采用PMMC瓣对放疗后复发性喉癌行挽救性全喉切除术（STL）的术后并发症发生率。
在2014年1月至2018年3月于东京医科大学医院接受治疗的162例喉癌患者中，我们纳入了11例行STL并应用PMMC瓣的患者。我们检查了患者的背景信息（年龄、性别、亚型、分期）、初始治疗（放疗/放化疗）、放疗剂量、照射区域、手术类型（有无颈部清扫）及术后并发症。
未出现严重的全身并发症。1例患者（8.3%）发生了严重局部并发症咽皮肤瘘，1例患者（8.3%）发生了轻度局部并发症伤口感染。
本院STL术后并发症发生率往往低于其他机构报道的发生率。
PIG在STL中可能是一种有用的手术方法。
