Tonsbeek Anthony M, Leidelmeijer Roxy, Hundepool Caroline A, Duraku Liron S, Van der Oest Mark J W, Sewnaik Aniel, Mureau Marc A M
Department of Plastic & Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands.
Cancers (Basel). 2024 May 8;16(10):1804. doi: 10.3390/cancers16101804.
Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques.
A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech.
Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23-47%) compared with other flaps ( < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types.
Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.
全喉切除术后存在多种重建下咽部分缺损的手术技术。本研究旨在调查和比较常用重建技术后的并发症及功能结果。
使用调查下咽部分缺损重建术后结果的研究进行系统评价和荟萃分析。感兴趣的结果包括瘘管、狭窄、皮瓣坏死、吞咽功能和术后语音。
在检索到的4035项研究中，本评价纳入了23项。报告了四种常见的重建技术，共794例患者：（1）胸大肌肌皮瓣和（2）肌筋膜瓣，（3）股前外侧游离皮瓣和（4）桡骨前臂游离皮瓣。与其他皮瓣相比，胸大肌肌皮瓣发生瘘管的频率显著更高（34%，95%CI 23-47%）（<0.001）。狭窄或皮瓣坏死发生率无显著差异。胸大肌肌筋膜瓣不劣于游离皮瓣重建。缺乏足够数据来评估不同皮瓣类型之间的语音结果。
考虑到胸大肌肌皮瓣瘘管发生率显著更高，对大多数患者而言，不应将其作为首选的重建方法。相比之下，胸大肌肌筋膜瓣与游离皮瓣重建相比产生了有前景的结果，值得进一步研究。
