NETWORK META-ANALYSIS: PHARYNGEAL CLOSURE AFTER A TOTAL LARYNGECTOMY

OBJECTIVE: Total laryngectomy (TL) is one of the techniques most often used for laryngeal cancer. One of the most common complications of TL is pharyngocutaneous fistula (PCF). The employed wound closure technique may affect the incidence rate of PCF after TL. The aim of this meta-analysis is to identify the steps with the least risk of PCF in each intervention. DATA SOURCES: The MEDLINE, Embase, Cochrane, Scopus and Web of Science (WOS) databases, using the following search terms: pharyngocutaneous, Suture, Closure, Shape, Stapler, Connell, Continuous, Layer, Flap, Salivary and Montgomery. REVIEW METHODS: The primary outcome measure was the appearance of PCF depending on the characteristics of the surgery: complete pharyngeal defect, partial pharyngeal defect, salvage or primary TL. Risk of bias was assessed using the relevant Cochrane tools, RoB2. RESULTS: This network meta-analysis included 95 studies with a total of 10,664 patients. For partial defects, the flap with the best results was jejune flap and using salivary bypass tube is recommended. In total defects, tissues with a tubular shape seem to be effective for pharyngeal reconstruction. In primary TL patients, the use of a stapler reduced the risk of developing PCF, and Connell-Mayo suture and tobacco-pouch suture showed the best results. In salvage TL, Vertical Straight continuous suture seems to have the least risk of developing PCF and the use of onlay flaps can be highly beneficial. CONCLUSION: Several factors seem to increase the development of PCF after TL, and so, more research should be carried out in this regard.