Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis
Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available e...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical Publishers, Inc.
2022-09-01
|
| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756347 |
| _version_ | 1811259001086672896 |
|---|---|
| author | Joseph M. Escandón Arbab Mohammad Saumya Mathews Valeria P. Bustos Eric Santamaría Pedro Ciudad Hung-Chi Chen Howard N. Langstein Oscar J. Manrique |
| author_facet | Joseph M. Escandón Arbab Mohammad Saumya Mathews Valeria P. Bustos Eric Santamaría Pedro Ciudad Hung-Chi Chen Howard N. Langstein Oscar J. Manrique |
| author_sort | Joseph M. Escandón |
| collection | DOAJ |
| description | Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1–13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1–43%), 7% (95% CI < 1–34%) for dermal graft interposition, < 1% (95% CI < 1–37%) for radial forearm free flap, < 1% (95% CI < 1–52%) for ligation of the fistula, 17% (95% CI < 1–64%) for interposition of a deltopectoral flap, 9% (95% CI < 1–28%) for primary closure, and 2% (95% CI < 1–20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives. |
| first_indexed | 2024-04-12T18:23:05Z |
| format | Article |
| id | doaj.art-dcce4e7123a6444cbfea14b632a8a829 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-12T18:23:05Z |
| publishDate | 2022-09-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-dcce4e7123a6444cbfea14b632a8a8292022-12-22T03:21:21ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712022-09-01490561763210.1055/s-0042-1756347Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-AnalysisJoseph M. Escandón0Arbab Mohammad1Saumya Mathews2Valeria P. Bustos3Eric Santamaría4Pedro Ciudad5Hung-Chi Chen6Howard N. Langstein7Oscar J. Manrique8Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New YorkDepartment of Surgery, Aarupadai Veedu Medical College and Hospital, Puducherry, Tamil Nadu, IndiaDepartment of Plastic and Microvascular Services, Tata Memorial Hospital, Mumbai, Maharashtra, IndiaDivision of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsDepartment of Plastic and Reconstructive Surgery, National Cancer Institute, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, MexicoReconstructive and Burn Surgery Department, Arzobispo Loayza National Hospital, Lima, PeruDepartment of Plastic Surgery, China Medical University Hospital, Taichung, TaiwanDivision of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New YorkDivision of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York, New YorkTracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1–13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1–43%), 7% (95% CI < 1–34%) for dermal graft interposition, < 1% (95% CI < 1–37%) for radial forearm free flap, < 1% (95% CI < 1–52%) for ligation of the fistula, 17% (95% CI < 1–64%) for interposition of a deltopectoral flap, 9% (95% CI < 1–28%) for primary closure, and 2% (95% CI < 1–20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756347puncturesprosthesis failuretracheoesophageal fistulawound closure techniquestep closurelaryngectomymeta-analysis |
| spellingShingle | Joseph M. Escandón Arbab Mohammad Saumya Mathews Valeria P. Bustos Eric Santamaría Pedro Ciudad Hung-Chi Chen Howard N. Langstein Oscar J. Manrique Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis Archives of Plastic Surgery punctures prosthesis failure tracheoesophageal fistula wound closure techniques tep closure laryngectomy meta-analysis |
| title | Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis |
| title_full | Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis |
| title_fullStr | Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis |
| title_short | Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis |
| title_sort | definitive closure of the tracheoesophageal puncture site after oncologic laryngectomy a systematic review and meta analysis |
| topic | punctures prosthesis failure tracheoesophageal fistula wound closure techniques tep closure laryngectomy meta-analysis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1756347 |
| work_keys_str_mv | AT josephmescandon definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis AT arbabmohammad definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis AT saumyamathews definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis AT valeriapbustos definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis AT ericsantamaria definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis AT pedrociudad definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis AT hungchichen definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis AT howardnlangstein definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis AT oscarjmanrique definitiveclosureofthetracheoesophagealpuncturesiteafteroncologiclaryngectomyasystematicreviewandmetaanalysis |