Costantino Andrea, Festa Bianca Maria, Kim Se-Heon, Baik Fred M, Wang Chen-Chi, Pirola Francesca, Malvezzi Luca, Spriano Giuseppe, Mercante Giuseppe, De Virgilio Armando
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
Microsurgery. 2023 Mar;43(3):286-296. doi: 10.1002/micr.30977. Epub 2022 Oct 19.
No consensus exists regarding the most effective reconstruction after total laryngectomy with partial pharyngectomy (TLwPP). This study aims to compare different reconstructive techniques (pectoralis major myo-cutaneous flap, PMMCF; anterolateral thigh flap, ALTF; radial forearm free flap, RFFF) after TLwPP in terms of pharyngocutaneous fistula (PCF), stenosis and feeding tube dependence (FTD) incidence.
The Scopus, PubMed/MEDLINE, Cochrane Library, and Google Scholar databases were searched. A single-arm meta-analysis was performed for PCF incidence, stenosis incidence, and FTD incidence on the entire cohort. An arm-based network analysis was conducted to compare three different surgical interventions (PMMCF, ALTF, RFFF).
A total of 13 studies and 232 patients were included in the network meta-analysis. The lowest PCF absolute risk was measured for the RFFF (11.7%, 95% CI: 2.8%-33.4%), compared to the ALTF (13.4%, 95% CI: 4.5%-32.1%) and the PMMC (49.0%, 95% CI: 19.2%-79.3%). The RFFF showed a stenosis absolute risk of 0.0% (95% CI: 0.0%-1.1%), while a higher stenosis incidence was measured for the ALTF (5.7%, 95% CI: 0.8%-25.2%) and the PMMCF (11.6%, 95% CI: 0.8%-55.1%). The RFFF showed the lowest absolute risk of FTD incidence (6.8%, 95% CI: 0.5%-28.1%) compared to the other reconstructive techniques (PMMCF: 12.4%, 95% CI: 2.4%-42.1%; ALTF: 17.5%, 95% CI: 6.4%-38.9%).
The RFFF seems the best choice for reconstruction of partial pharyngeal defects after TLwPP due to the lower incidence of PCF, stenosis and FTD compared to the ALTF and the PMMCF.
对于全喉切除联合部分咽切除术（TLwPP）后最有效的重建方式尚无共识。本研究旨在比较TLwPP术后不同重建技术（胸大肌肌皮瓣，PMMCF；股前外侧皮瓣，ALTF；桡骨前臂游离皮瓣，RFFF）在咽皮肤瘘（PCF）、狭窄和依赖饲管（FTD）发生率方面的差异。
检索Scopus、PubMed/MEDLINE、Cochrane图书馆和谷歌学术数据库。对整个队列的PCF发生率、狭窄发生率和FTD发生率进行单臂荟萃分析。进行基于组的网络分析以比较三种不同的手术干预措施（PMMCF、ALTF、RFFF）。
网络荟萃分析共纳入13项研究和232例患者。与ALTF（13.4%，95%CI：4.5%-32.1%）和胸大肌肌皮瓣（PMMC，49.0%，95%CI：19.2%-79.3%）相比，RFFF的PCF绝对风险最低（11.7%，95%CI：2.8%-33.4%）。RFFF的狭窄绝对风险为0.0%（95%CI：0.0%-1.1%），而ALTF（5.7%，95%CI：0.8%-25.2%）和PMMCF（11.6%，95%CI：0.8%-55.1%）的狭窄发生率更高。与其他重建技术相比，RFFF的FTD发生率绝对风险最低（6.8%，95%CI：0.5%-28.1%）（PMMCF：12.4%，95%CI：2.4%-42.1%；ALTF：17.5%，95%CI：6.4%-38.9%）。
与ALTF和PMMCF相比，RFFF因PCF、狭窄和FTD发生率较低，似乎是TLwPP术后部分咽缺损重建的最佳选择。
