Rao Karthik Nagaraja, Arora Ripu Daman, Singh Ambesh, Nagarkar Nitin M, Aggarwal Aakash
Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India.
Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India.
Indian J Surg Oncol. 2022 Dec;13(4):797-808. doi: 10.1007/s13193-022-01581-z. Epub 2022 Jul 5.
Pharyngocutaneous fistula (PCF) is the most common complication which significantly increases morbidity. High-level evidence is lacking that determines the PCF rates in the primary laryngectomy. The main objective of this study was to systematically identify the factors leading to the PCF formation in primary laryngectomy. Human studies reporting at least one risk factor for developing PCF in patients undergoing primary total laryngectomy for laryngeal cancer were included. PubMed, EMBASE, and Cochrane databases were searched for the data extraction. Risk of bias assessment tool for non-randomized trial tool was used. Cochrane's test and Higgin's -heterogeneity was applied. The Mantel-Haenszel and DerSimonian Laird method was employed. Odds ratio was calculated for each risk factor, a -value < 0.05 was considered as statistically significant. PROSPERO registration CRD42021248382. The meta-analysis comprised a total of 2446 patients in 14 included non-randomized studies. The among the analyzed risk factors-comorbidities (OR 2.781, R: 1.892-4.088, < 0.001), site of tumor (OR 4.485, R: 3.003-6.699, < 0.001), low pre-operative hemoglobin (OR 3.590, R: 2.130-6.050, < 0.001), low pre-operative albumin (OR 2.833, R: 1.596-5.031, < 0.001), utilization of surgical staplers (OR 0.172, R: 0.064-0.460, < 0.001) (protective effect), positive mucosal margin (OR 4.92 R: 1.90-12.75, = 0.001). The risk factors for PCF in patients undergoing primary TL included comorbidities, hypopharyngeal involvement, pre-operative hemoglobin and albumin, stapler usage, and positive mucosal margin. Level of Evidence - III.
The online version contains supplementary material available at 10.1007/s13193-022-01581-z.
咽皮肤瘘（PCF）是最常见的并发症，会显著增加发病率。目前缺乏确定原发性喉切除术患者PCF发生率的高级别证据。本研究的主要目的是系统地确定原发性喉切除术中导致PCF形成的因素。纳入了关于接受原发性全喉切除术治疗喉癌患者中至少报告一种PCF发生风险因素的人体研究。检索了PubMed、EMBASE和Cochrane数据库以进行数据提取。使用了非随机试验工具的偏倚风险评估工具。应用了Cochrane检验和Higgin's I² - 异质性检验。采用了Mantel - Haenszel法和DerSimonian Laird法。计算每个风险因素的比值比，P值 < 0.05被认为具有统计学意义。PROSPERO注册号CRD42021248382。该荟萃分析共纳入14项非随机研究中的2446例患者。分析的风险因素包括合并症（OR 2.781，95%CI：1.892 - 4.088，P < 0.001）、肿瘤部位（OR 4.485，95%CI：3.003 - 6.699，P < 0.001）、术前血红蛋白水平低（OR 3.590，95%CI：2.130 - 6.050，P < 0.001）、术前白蛋白水平低（OR 2.833，95%CI：1.596 - 5.031，P < 0.001）、使用手术吻合器（OR 0.172，95%CI：0.064 - 0.460，P < 0.001）（保护作用）、切缘阳性（OR 4.92，95%CI：1.90 - 12.75，P = 0.001）。原发性全喉切除术患者发生PCF的风险因素包括合并症、下咽受累、术前血红蛋白和白蛋白水平、吻合器使用情况以及切缘阳性。证据级别 - III。
在线版本包含可在10.1007/s13193 - 022 - 01581 - z获取的补充材料。
