Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

• Published in: Archives of plastic surgery Vol. 49; no. 5; pp. 617 - 632
• Main Authors: Escandón, Joseph M., Mohammad, Arbab, Mathews, Saumya, Bustos, Valeria P., Santamaría, Eric, Ciudad, Pedro, Chen, Hung-Chi, Langstein, Howard N., Manrique, Oscar J.
• Format: Journal Article
• Language: English
• Published: 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Thieme Medical Publishers, Inc 01.09.2022; 대한성형외과학회
• Subjects: laryngectomy; meta-analysis; Pediatric/Craniomilofacial/Head & Neck: Review; Pediatric/Craniomilofacial/Head & Neck: Review Article; prosthesis failure; punctures; tep closure; tracheoesophageal fistula; wound closure techniques; 성형외과학; punctures; laryngectomy; tracheoesophageal fistula; wound closure techniques; meta-analysis; TEP closure; prosthesis failure
• ISSN: 2234-6163; 2234-6171
• DOI: 10.1055/s-0042-1756347

Abstract 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.