Department of Otolaryngology Head & Neck Surgery, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
Department of Otolaryngology Head & Neck Surgery, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
Oral Oncol. 2022 Nov;134:106069. doi: 10.1016/j.oraloncology.2022.106069. Epub 2022 Aug 12.
Pharyngocutaneous fistula (PCF) is a devastating complication of laryngectomy. Different factors, principally previous irradiation, increases the risk for PCF formation. The current study objectives is to investigate the potential negative effect of re-irradiation on fistula development. Materilas and methods This is a single, referral, medical center retrospective, cohort study, conducted between the years 2011-2021. Electronic medical files, surgical notes, laboratory records and radiation plan (dose and time interval in case of re-irradiation) were examined. Main outcomes and measures Risk and predictors associated with PCF formation. Risk and severity of PCF in the setting of re-irradiation.
Overall, 27 laryngectomized patients were investigated, of whom 21 patients had single radiation (pre or post-operative radiation) and the other 6 patients had two radiation treatments (before and after laryngectomy). The fistula rate was 33.33% (7/21) in the single radiation compared (p = 0.14) to 66.66% (4/6) in the re-irradiation group of patients (including late-onset fistulas). All single radiation PCF were self-limited, whereas, 3 out of 4 fistulas in the re-irradiation group were longstanding or permanent. In the re-irradiation group of patients, a shorter time interval between the first and second radiation treatments was demonstrated among those with fistula formation compared to patients with uneventful laryngectomy (p = 0.08).
Re-irradiation and especially a brief interval between the radiation treatments is associated with a severe PCF.
咽皮瘘（PCF）是喉切除术的一种破坏性并发症。先前的放疗等不同因素会增加 PCF 形成的风险。本研究旨在探讨再次放疗对瘘管形成的潜在负面影响。
这是一项在 2011 年至 2021 年间进行的单中心回顾性队列研究。检查了电子病历、手术记录、实验室记录和放疗计划（如果进行再放疗，剂量和时间间隔）。
研究了 27 例接受喉切除术的患者，其中 21 例患者接受单次放疗（术前或术后放疗），6 例患者接受两次放疗（喉切除术前后）。在单次放疗中，瘘管发生率为 33.33%（7/21）（p=0.14），而在再次放疗组患者中，瘘管发生率为 66.66%（4/6）（包括迟发性瘘管）。所有单次放疗的 PCF 均为自限性，而再放疗组的 4 个瘘管中有 3 个为持续性或永久性瘘管。在再次放疗组患者中，与无并发症喉切除术患者相比，瘘管形成患者第一次和第二次放疗之间的时间间隔更短（p=0.08）。
再次放疗，尤其是放疗之间的间隔较短，与严重的 PCF 相关。
