Mesolella Massimo, Allosso Salvatore, Petruzzi Gerardo, Evangelista Antonietta, Motta Giovanni, Motta Gaetano
Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy.
Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy.
Cancers (Basel). 2024 Feb 13;16(4):768. doi: 10.3390/cancers16040768.
The aim of this prospective study was to investigate the role of procalcitonin as an early diagnostic marker of pharyngocutaneous fistula (PCF) in a cohort of head and neck patients treated with total laryngectomy for squamous cell carcinoma.
This prospective study was conducted on a sample of patients enrolled from January 2019 to March 2022. All patients were subjected to a "protocol" of blood chemistry investigations, scheduled as follows: complete blood count with formula, ESR dosage, CPR, and PCT. PCT was also dosed by salivary sampling and a pharyngo-cutaneous swab in patients who presented with PCF. The dosage scheme was systematically repeated: the day before the intervention (t0); the 5th day postoperative (t1); the 20th day postoperative (t2); and at time X, the day of the eventual appearance of the pharyngocutaneous fistula.
A total of 36 patients met the inclusion criteria. The patients enrolled in the study were subsequently divided into two groups: 27 patients underwent total laryngectomy (TL) for laryngeal cancer without postoperative complications, and 9 patients were undergoing TL with postoperative PCF. Using the Cochran's Q test, statistical significance was found for PCT among T0, T1, Tx, and T2 (-value < 0.001) between the PCF and non-PCF groups. The Z test demonstrated that there is a difference in PCT levels at T1 and T2 and that this difference is statistically significant ( < 0.001).
PCT could be considered an early marker of complications in open laryngeal surgery. According to our results, it could be useful in the precocious detection of pharyngocutaneous fistulas and in the management of antibiotic therapy.
本前瞻性研究旨在调查降钙素原作为头颈部鳞状细胞癌全喉切除术后咽皮肤瘘（PCF）早期诊断标志物的作用。
本前瞻性研究对2019年1月至2022年3月纳入的患者样本进行。所有患者均接受如下安排的血液化学检查“方案”：血常规及分类、血沉测定、CPR和PCT。对于出现PCF的患者，还通过唾液采样和咽皮肤拭子检测PCT。该检测方案系统性重复进行：干预前一天（t0）；术后第5天（t1）；术后第20天（t2）；以及在X时间，即咽皮肤瘘最终出现之日。
共有36例患者符合纳入标准。研究纳入的患者随后分为两组：27例因喉癌接受全喉切除术（TL）且无术后并发症，9例接受TL术后出现PCF。使用 Cochr an's Q检验，发现PCF组和非PCF组之间在T0、T1、Tx和T2时PCT具有统计学意义（P值<0.001）。Z检验表明，T1和T2时PCT水平存在差异，且该差异具有统计学意义（P<0.001）。
PCT可被视为开放性喉手术并发症的早期标志物。根据我们的结果，它可能有助于早期发现咽皮肤瘘及抗生素治疗管理。
