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Objectives The aim of the current study was to evaluate the functional outcomes of stapler pharyngeal closure after total laryngectomy by the incidence of PCT and assessment of swallowing after surgery. In addition, the study aimed to evaluate the oncological outcomes in terms of patients’ survival rates. Methods This randomized clinical trial was conducted on 58 patients with advanced laryngeal carcinoma who underwent total laryngectomy. Patients were randomly assigned to two groups according to the method of pharyngeal repair after laryngectomy: manual closure group (n = 28), and stapler group (n = 30). Functional and oncological outcomes were assessed and compared. Results The incidence of pharyngocutaneous fistula was significantly less in the stapler group. Additionally, operative time was significantly shorter and swallowing function was better in the stapler group compared to the manual group. There was no statistically significant difference between groups regarding survival rates. Conclusion The stapler is a reliable method for pharyngeal closure after total laryngectomy if the limits of its indications regarding the primary tumor are considered. Stapler closure decreases the incidence of PCF and decreases the surgical time. Good swallowing outcomes are achieved without compromising the oncological outcomes.

This study aimed to assess the utility of onlay pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage total laryngectomy. A retrospective analysis was performed of 172 patients who underwent salvage laryngectomy for recurrent carcinoma of the larynx or hypopharynx between 1999 and 2014. One hundred and ten patients underwent primary closure and 62 patients had pectoralis major myofascial flap onlay. The overall pharyngocutaneous fistula rate was 43 per cent, and was similar in both groups (primary closure group, 43.6 per cent; onlay flap group, 41.9 per cent; p = 0.8). Fistulae in the onlay flap group healed faster: the median and mean fistula duration were 37 and 55 days, respectively, in the primary closure group and 20 and 25 days, respectively, in the onlay flap group (p = 0.008). Use of an onlay pectoralis major myofascial flap did not decrease the pharyngocutaneous fistula rate, although fistula duration was shortened. A well-designed randomised-controlled trial is needed to establish parameters for its routine use in clinical practice.

56 patients affected by T2 glottic carcinoma were treated in two institutes using transoral laser microsurgery (TLM) in 40 cases and vertical hemilaryngectomy in 16 cases between September 2012 and September 2015. In the TLM group, different subtypes of type V cordectomy were used according to the extent of tumor. In the vertical hemilaryngectomy group, classical operation was used in most of the cases and the resection was extended in few cases. Analysis of post-operative swallowing function was done using videofluoroscopy (VFS), functional endoscopic evaluation of swallowing, and subjectively using MD Anderson dysphagia inventory. Objective evaluation of swallowing has been made by obtaining different measures from VFS (pharyngeal transit time, pharyngeal constriction ratio, and hyoid displacement for example). Analysis also included the need and duration of tracheostomy and nasogastric tube, ICU admission, and hospitalization time. Statistical analysis was performed with the Mann–Whitney U and Pearson Chi-square tests. Comparison of incidence of aspiration and swallowing outcome showed significantly better results in the laser group than in the vertical group ( p  < 0.001). The duration of ICU, tracheostomy, nasogastric tube, and hospital stay was also significantly shorter in the laser group ( p  < 0.001). This study shows that TLM had significantly better overall postoperative outcome than vertical hemilaryngectomy. It was associated with significantly shorter hospital stay and less need for tracheostomy, nasogastric tube, and ICU admission). Measures obtained from VFS are useful for detection and follow-up of postoperative aspiration, because it is a definitive technique for anatomical and physiological study of swallowing.

Floseal(®) can be of value in reducing blood loss and haematoma rates. The manufacturer's warnings include allergic reaction, poor wound healing and intravascular thrombosis. We aimed to determine whether Floseal(®) is safe to use in various head and neck surgery procedures. A prospective trial was conducted using Floseal(®) in 42 various consecutive head and neck surgery procedures. Adverse incidents were used as the main outcome measure, including allergic reaction, wound breakdown, wound infection and thrombosis. Secondary outcome measures included haematoma formation, hospital stay, drain times and output. No adverse incidents were recorded in the trial period. Two patients developed haematomas and required surgical exploration where a bleeding vessel was identified and dealt with. Floseal(®) is safe to be used in head and neck surgery with no adverse effects. A larger number and a control group are required to ascertain its value in reducing blood loss, haematoma formation, drain usage and hospital stay.

Objective The purpose of this study was to systematically evaluate the risk factors of pharyngocutaneous fistula (PCF) after total laryngectomy. Methods We systematically searched Pubmed, Web of Science, Cochrane Library, and Embase databases and included the literature according to the inclusion and exclusion criteria. Results A total of 52 studies with 8605 patients were included in the meta-analysis. The total incidence of PCF was 21% (1808/8605). Meta-analysis results indicated that age (OR = 1.29, 95% CI 1.06–1.58, P  = 0.01), smoking (OR = 1.62, 95% CI 1.27–2.07, P  < 0.01), COPD (chronic obstructive pulmonary disease) (OR = 1.62, 95% CI 1.19–2.22, P  < 0.01), CAD (coronary atherosclerotic heart disease) (OR = 1.82, 95% CI 1.36–2.45, P  < 0.01), T-stage (OR = 0.81, 95% CI 0.67–0.98, P  = 0.03), previous radiotherapy (OR = 2.41, 95% CI 2.00–2.90, P  < 0.01), preoperative albumin (OR = 2.95, 95% CI 1.47–5.91, P  < 0.01), preoperative hemoglobin (OR = 1.97, 95% CI 1.28–3.03, P  < 0.01), tumor site (OR = 0.28, 95% CI 0.22–0.36, P  < 0.01), and treatment method (OR = 1.85, 95% CI 1.44–2.38, P  < 0.01) were risk factors associated with PCF. Conclusions In our study, age, smoking, COPD, CAD, T-stage, previous radiotherapy, preoperative albumin, preoperative hemoglobin, tumor site, and treatment method were risk factors of PCF.

Partial frontolateral laryngectomy (PL) is performed to remove larynx tumor while preserving its main functions. So far, the speech changes induced by difficulties of voicing and the alterations to the vocal tract due to PL have been seldom addressed. The goal of our study was to make an acoustic analysis of regressive voicing assimilation (RVA) among patients after PL and to study the relationship with rates of speech. A retrospective study was conducted from January to April 2013. 11 subjects treated by partial frontolateral laryngectomy, and ten healthy subjects were included. Functional recordings of voice were analyzed and compared. For assimilation sequences we found a significant modification of voicing ratio in healthy subjects ( p  < 0.05) and PL patient at accelerated speaking rate only ( p  < 0.05). The vowel duration is significantly modified only for healthy subjects. For all subjects (PL patients and healthy) the duration of C1 consonant was not significantly modified. Our results highlight the presence of RVA in healthy subjects, but also in PL patients in the rapid speaking mode.

We present the oncological and functional results of surgical transoral resection of supraglottic laryngeal carcinomas using microelectrodes. This prospective multicentre trial was conducted from 2005 to 2009. It included 54 patients (23 T1, 14 T2, and 17 T3) with supraglottic cancer, with a follow-up of 2 years. Outcome measurements were: tracheostomy, hospital stay, nasogastric feeding and recurrences. Four patients required permanent tracheostomies. The mean hospital stay was 8.1 days. Temporary nasogastric feeding was necessary in 13 patients. Postoperative complications included two incidences of haemorrhage requiring surgical intervention and one pneumonia. Four patients out of eight with T3 tumours had regional recurrence; in these cases salvage surgery was performed: two cases by the transoral approach and six total laryngectomies. Clinical results were similar to those obtained with CO 2 laser therapy. We list other advantages of the technique and include a literature review.

To investigate the influence of early dysphagia on quality of life in patients with partial laryngectomy, and to investigate the application value of Flexible Endoscopic Evaluation of Swallowing (FEES). This study included 30 inpatients who underwent partial laryngectomy due to laryngeal cancer. In the early postoperative period, a comprehensive assessment was conducted on each patient, encompassing Videofluoroscopic Swallowing Study (VFSS), Flexible Endoscopic Evaluation of Swallowing (FEES), and MD Anderson Dysphagia Inventory (MDADI). Each patient underwent two evaluations at different time points following the surgical procedure, all conducted on the same day. The patients’ first MDADI assement score after surgery was 45.4 ± 3.6 points, and the second score was 54.7 ± 13.4 points. VFSS as the gold standard, FEES showed good sensitivity (84%) and specificity (94%) for detecting aspiration, as well as good sensitivity (78%) and moderate specificity (86%) for detecting penetration. The Kappa consistency test results showed high consistency between FEES and VFSS swallowing function evaluations (Kappa value = 0.669); evaluations of thin liquid, thick liquid, and solid bolus had high consistency (Kappa value = 0.631, 0.675, and 0.678, respectively), while evaluations of semi-liquid bolus had poor consistency (Kappa value = 0.598); evaluations of four bolus sizes all had high consistency (Kappa value = 0.658, 0.647, 0.705, 0.670). The Kappa values for evaluating patients undergoing horizontal partial laryngectomy, vertical partial laryngectomy, and supraglottic laryngectomy were 0.572, 0.604, and 0.680, respectively. This study shows that dysphagia is an important problem affecting the early quality of life of patients after partial laryngectomy, and early instrumental evaluation is also extremely important. This study also emphasizes the reliability problems in the identification of false invasion and aspiration. FEES can be used to evaluate the early swallowing function of patients after partial laryngectomy, thus guiding the timing and type of eating, and evaluating the rehabilitation effect. In addition, compared with VFSS, FEES have more advantages for the identification of penetration.

Background The leakage of saliva through the deep neck region from a pharyngocutaneous fistula could cause devastating complications, including vascular ruptures leading to mortality. While a partial pharyngoesophageal defect is created after total laryngectomy, a patch pattern of hypopharyngeal reconstruction is required, for which a fasciocutaneous free flap is usually applied. If radiotherapy fails to cure pharyngeal cancer, salvage total laryngectomy (STL) is needed. However, postradiation tissues tend not to heal well, and the incidence of pharyngocutaneous fistula therefore increases. We proposed an edge-epithelialization method to address this problem and conducted a retrospective study for comparison. Methods The inclusion criteria were patients with head and neck cancer who underwent total laryngectomy that immediately required patch free flap reconstruction at a single medical center (January 2012–December 2021). Receipt of presurgical radiotherapy, hospitalization duration, and the presence of postoperative complications were recorded. Results The included patients were separated into two groups: Group A (edge de-epithelialization not adopted) ( n  = 79) and Group B (edge de-epithelialization adopted) ( n  = 51). Forty-four and twenty-two patients in Groups A and Group B, respectively, received preoperative radiotherapies and simultaneous STL and fasciocutaneous free flap reconstructions. The incidence of pharyngocutaneous fistula was significantly lower in Group B ( p  = 0.0145). This phenomenon was the same for patients who underwent preoperative radiotherapy only ( p  = 0.0470) but not for patients who did not receive preoperative radiotherapy ( p  = 0.2363). Conclusions Edge de-epithelialization is an effective method for reducing pharyngocutaneous fistula formation in patch free flap reconstructions after STLs.

Purpose The purpose of this study was to analyse the oncologic results of open partial horizontal laryngectomy (OPHL) and to assess the prognostic factors that could affect the survival of patients affected by T2, T3 and T4a laryngeal cancer. Using this data, we aim to identify clinical criteria to select patients amenable to conservative surgery, and to facilitate a more targeted approach in the management of advanced laryngeal cancer. Methods A retrospective study was performed in patients who underwent OPHL type II for laryngeal squamous cell carcinoma from January 2005 to December 2018. We analysed a total of 170 patients; 21(12.36%) cases were staged as pT2, 116 (68.23%) as pT3 and 33 (19.41%) as pT4a. Results Five-year overall survival (OS) was 80.9%, 79.3%, 70.4% for T2, T3 and T4 respectively. Disease-specific survival (DSS) was 90.4%, 85.3% and 77.4%. Posterior tumour extension, perineural invasion and N status showed to considerably influence survival in both uni- and multivariate analyses. Conclusion The oncological outcomes from our study show that OPHL for advanced laryngeal cancer can guarantee a high percentage of success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery, and treatment options should consider selected criteria based on tumour and patient features.