Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Effects of perioperative radiation treatment on stricture and fistula formation in hypopharyngeal reconstruction: a meta-analysis

  • Shin, Jin Yong (Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School) ;
  • Lee, Sun-Young (Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital) ;
  • Roh, Si-Gyun (Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School) ;
  • Lee, Nae-Ho (Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School)
  • Received : 2021.03.10
  • Accepted : 2021.03.30
  • Published : 2021.04.20
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Abstract

Hypopharyngeal reconstruction is a surgically challenging procedure, and postoperative management is important due to a high rate of complications following surgery. In particular, stricture and fistula formation is the most common long-term postoperative complication. Through systematic review and meta-analysis of 21 studies, a significant radiation effect of stricture and fistula formation was found in patients who underwent hypopharyngeal reconstruction. The perioperative radiation must be seen as a critical factor for stricture and fistula formation in hypopharyngeal reconstruction.

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References

  1. Disa JJ, Pusic AL, Hidalgo DA, Cordeiro PG. Microvascular reconstruction of the hypopharynx: defect classification, treatment algorithm, and functional outcome based on 165 consecutive cases. Plast Reconstr Surg 2003;111:652-60. https://doi.org/10.1097/01.PRS.0000041987.53831.23
  2. Suh JM, Chung CH, Chang YJ. Head and neck reconstruction using free flaps: a 30-year medical record review. Arch Craniofac Surg 2021;22:38-44. https://doi.org/10.7181/acfs.2020.00745
  3. Clark JR, Gilbert R, Irish J, Brown D, Neligan P, Gullane PJ. Morbidity after flap reconstruction of hypopharyngeal defects. Laryngoscope 2006;116:173-81. https://doi.org/10.1097/01.mlg.0000191459.40059.fd
  4. Anthony JP, Singer MI, Deschler DG, Dougherty ET, Reed CG, Kaplan MJ. Long-term functional results after pharyngoesophageal reconstruction with the radial forearm free flap. Am J Surg 1994;168:441-5. https://doi.org/10.1016/S0002-9610(05)80095-9
  5. Scharpf J, Esclamado RM. Reconstruction with radial forearm flaps after ablative surgery for hypopharyngeal cancer. Head Neck 2003;25:261-6. https://doi.org/10.1002/hed.10197
  6. Markou KD, Vlachtsis KC, Nikolaou AC, Petridis DG, Kouloulas AI, Daniilidis IC. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence? Eur Arch Otorhinolaryngol 2004;261:61-7. https://doi.org/10.1007/s00405-003-0643-6
  7. Choi S, Schwartz DL, Farwell DG, Austin-Seymour M, Futran N. Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. Arch Otolaryngol Head Neck Surg 2004;130:1308-12. https://doi.org/10.1001/archotol.130.11.1308
  8. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700. https://doi.org/10.1136/bmj.b2700
  9. Hsueh JH, Hsieh YH, Lin YS, Lin YS, Yang KC, Liu WC. A novel application of double-paddle peroneal chimeric flap as external sentinel monitor in hypopharyngeal reconstruction. Ann Plast Surg 2017;78(3 Suppl 2):S70-5. https://doi.org/10.1097/SAP.0000000000001009
  10. Zhang C, Chen S, Zhu M, Chen D, Chen H, Zheng H. Combined use of gastric pull-up and pectoralis major flaps for massive defects after total laryngopharyngoesophagectomy in patients with advanced hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2015;272:3557-64. https://doi.org/10.1007/s00405-014-3358-y
  11. Song M, Chen SW, Zhang Q, Yang AK, Zhuang SM, Wang LP, et al. External monitoring of buried radial forearm free flaps in hypopharyngeal reconstruction. Acta Otolaryngol 2011;131:204-9. https://doi.org/10.3109/00016489.2010.518157
  12. Andrades P, Pehler SF, Baranano CF, Magnuson JS, Carroll WR, Rosenthal EL. Fistula analysis after radial forearm free flap reconstruction of hypopharyngeal defects. Laryngoscope 2008;118:1157-63. https://doi.org/10.1097/MLG.0b013e31816f695a
  13. Zhang C, Zhu M, Chen M, Chen D, Chen S, Zheng H. Free flap combined with pectoralis major flap for reconstruction after total laryngopharyngectomy in patients with advanced hypopharyngeal carcinoma. Acta Otolaryngol 2016;136:841-6. https://doi.org/10.3109/00016489.2016.1164891
  14. Chahine KA, Chaffanjon P, Bettega G, Lebeau J, Reyt E, Righini CA. Gastro-omental free flap in the reconstruction of the unfavourable hypopharyngeal defects: a functional assessment. J Plast Reconstr Aesthet Surg 2009;62:1367-73. https://doi.org/10.1016/j.bjps.2008.05.042
  15. Amin AA, Rifaat M, Ellabban MA, Zedan M, Kamel M, Bassiouny M. Transaxillary thoracodorsal artery perforator flap: a versatile new technique for hypopharyngeal reconstruction. J Reconstr Microsurg 2014;30:397-404. https://doi.org/10.1055/s-0034-1376532
  16. Yang CC, Lee JC, Wu KC, Chang SH. Voice and speech outcomes with radial forearm free flap-accompanied phonation tube after total pharyngolaryngectomy of hypopharyngeal cancer. Acta Otolaryngol 2011;131:847-51. https://doi.org/10.3109/00016489.2011.570787
  17. Hsiao HT, Leu YS, Chang YC, Yang JC, Tung KY. Voice and swallowing after laryngopharyngectomy and free ileocolic flap reconstruction for hypopharyngeal cancer. Ann Plast Surg 2009;62:390-4. https://doi.org/10.1097/SAP.0b013e31819031dc
  18. Kim SC, Kim EK. Externalized monitoring of totally buried free flap in hypopharyngeal reconstruction. J Craniofac Surg 2013;24:575-8. https://doi.org/10.1097/SCS.0b013e31827c8077
  19. Fujiwara T, Shih HS, Chen CC, Tay SK, Jeng SF, Kuo YR. Interdigitation of the distal anastomosis between tubed fasciocutaneous flap and cervical esophagus for stricture prevention. Laryngoscope 2011;121:289-93. https://doi.org/10.1002/lary.21289
  20. Laing TA, Van Dam H, Rakshit K, Dilkes M, Ghufoor K, Patel H. Free jejunum reconstruction of upper esophageal defects. Microsurgery 2013;33:3-8. https://doi.org/10.1002/micr.21992
  21. Lee JC, Hsu WT, Yang CC, Chang SH. A fabricated forearm free flap with accompanying phonation tube for simultaneous reconstruction of a pharyngolaryngeal circumferential defect and voice loss: new surgical modification with functional phonation outcome. Laryngoscope 2013;123:344-9. https://doi.org/10.1002/lary.23631
  22. Ooi ASH, Teven CM, Inbal A, Chang DW. The utility of the musculocutaneous anterolateral thigh flap in pharyngolaryngeal reconstruction in the high-risk patient. J Surg Oncol 2017;115:842-7. https://doi.org/10.1002/jso.24577
  23. Scaglioni MF, Lin TS, Chen YC, Tsai YT, Yang CH, Wu CC, et al. The free inverted omega-shaped flap for circumferential hypopharyngeal reconstruction with simultaneous neck skin defect. Microsurgery 2018;38:51-9. https://doi.org/10.1002/micr.30056
  24. Parmar S, Al Asaadi Z, Martin T, Jennings C, Pracy P. The anterolateral fasciocutaneous thigh flap for circumferential pharyngeal defects: can it really replace the jejunum? Br J Oral Maxillofac Surg 2014;52:247-50. https://doi.org/10.1016/j.bjoms.2013.12.008
  25. Zelken JA, Kang CJ, Huang SF, Liao CT, Tsao CK. Refinements in flap design and inset for pharyngoesophageal reconstruction with free thigh flaps. Microsurgery 2017;37:112-8. https://doi.org/10.1002/micr.22432
  26. Yu P, Lewin JS, Reece GP, Robb GL. Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap. Plast Reconstr Surg 2006;117:968-74. https://doi.org/10.1097/01.prs.0000200622.13312.d3
  27. Yu P, Robb GL. Pharyngoesophageal reconstruction with the anterolateral thigh flap: a clinical and functional outcomes study. Plast Reconstr Surg 2005;116:1845-55. https://doi.org/10.1097/01.prs.0000191179.58054.80
  28. Lewin JS, Barringer DA, May AH, Gillenwater AM, Arnold KA, Roberts DB, et al. Functional outcomes after laryngopharyngectomy with anterolateral thigh flap reconstruction. Head Neck 2006;28:142-9. https://doi.org/10.1002/hed.20308
  29. Nakatsuka T, Harii K, Asato H, Ebihara S, Yoshizumi T, Saikawa M. Comparative evaluation in pharyngo-oesophageal reconstruction: radial forearm flap compared with jejunal flap: a 10-year experience. Scand J Plast Reconstr Surg Hand Surg 1998;32:307-10. https://doi.org/10.1080/02844319850158651
  30. Su CY, Chiang YC. The fabricated radial forearm flap in pharyngolaryngeal surgery: saliva leakage and its prevention. Br J Plast Surg 1995;48:212-7. https://doi.org/10.1016/0007-1226(95)90004-7
  31. Perez CA, Stanley K, Rubin P, Kramer S, Brady L, Perez-Tamayo R, et al. A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung. Preliminary report by the Radiation Therapy Oncology Group. Cancer 1980;45:2744-53. https://doi.org/10.1002/1097-0142(19800601)45:11<2744::AID-CNCR2820451108>3.0.CO;2-U
  32. Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys 1995;31:1213-36. https://doi.org/10.1016/0360-3016(94)00419-L
  33. Mavroidis P, Laurell G, Kraepelien T, Fernberg JO, Lind BK, Brahme A. Determination and clinical verification of dose-response parameters for esophageal stricture from head and neck radiotherapy. Acta Oncol 2003;42:865-81. https://doi.org/10.1080/02841860310012833
  34. Kim HS, Chung CH, Chang YJ. Free-flap reconstruction in recurrent head and neck cancer: a retrospective review of 124 cases. Arch Craniofac Surg 2020;21:27-34. https://doi.org/10.7181/acfs.2019.00738
  35. Guelinckx PJ, Boeckx WD, Fossion E, Gruwez JA. Scanning electron microscopy of irradiated recipient blood vessels in head and neck free flaps. Plast Reconstr Surg 1984;74:217-26. https://doi.org/10.1097/00006534-198408000-00008
  36. Erkan M, Hausmann S, Michalski CW, Schlitter AM, Fingerle AA, Dobritz M, et al. How fibrosis influences imaging and surgical decisions in pancreatic cancer. Front Physiol 2012;3:389. https://doi.org/10.3389/fphys.2012.00389
  37. Bengtson BP, Schusterman MA, Baldwin BJ, Miller MJ, Reece GP, Kroll SS, et al. Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction. Am J Surg 1993;166:326-30. https://doi.org/10.1016/S0002-9610(05)80325-3
  38. Kiener JL, Hoffman WY, Mathes SJ. Influence of radiotherapy on microvascular reconstruction in the head and neck region. Am J Surg 1991;162:404-7. https://doi.org/10.1016/0002-9610(91)90159-B

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