Análisis de factores predictivos en la aparición de fístulas faringocutáneas poslaringectomía total / Analysis or predictive factors associated with pharingocutaneous fistulas after total laryngectomy

RESUMEN Antecedentes: la fístula faringocutánea es la complicación más común luego de una laringectomía total. Los factores implicados en su aparición son estudiados por numerosos autores sin obtener resultados concluyentes. Objetivo: Evaluar las causas de aparición de fístula faringocutánea y describir los factores de riesgo implicados en la aparición de fístulas faringocutáneas en la población estudiada. Material y métodos: estudio retrospectivo, observacional, con análisis estadístico de variables. Se consideraron 55 pacientes a quienes se les realizó una laringectomía total inicialmente o como rescate, desde enero de 2000 hasta diciembre de 2019, con una proporción hombre/mujer de 48/7. La edad media fue de 61,3 años. El 96,36% con diagnóstico anatomopatológico de carcinoma epidermoide. Análisis estadístico (prueba de chi cuadrado-prueba de Mann-Whitney) de variables relacionadas con la aparición de fístula faringocutánea. Resultados: la incidencia de fístulas alcanzó el 20% de los pacientes laringectomizados. Cerraron espontáneamente el 72,73% de las fístulas y requirieron el uso de colgajos, 3 (27,27%) pacientes. De los pacientes fistulizados, el 63,64% tenían radioterapia previa. El uso de sonda nasogástrica para alimentación se prolongó en dichos pacientes por más de 15 días. El tiempo de internación promedio de los pacientes fistulizados fue de 23 días. Conclusión: en nuestro medio, el factor más asociado a la aparición de fístulas tras laringectomía fue el uso de radioterapia previa. La fístula en estos pacientes tardó más tiempo en cerrarse y requirió en algunos casos reconstrucciones más complejas.

ABSTRACT Background: Pharyngocutaneous fistula is the most common complication after total laryngectomy. The factors associated with its development have been studied by several authors without conclusive results. Objective: To evaluate the causes for the development of PCF and to describe the risk factors associated with PCF in the population studied. Material and methods: We conducted a retrospective and observational study with statistical analysis of the variables. A total of 55 patients undergoing initial or salvage total laryngectomy from January 2000 to December 2019 were included. Male-to-female ratio was 48/7. Mean age was 61.3 years. The pathological diagnosis was epidermoid carcinoma in 96.36% of the cases. Statistical analysis: (chi square test and Mann-Whitney test) of the variables related with the development of pharyngocutaneous fistula. Results: The incidence of fistula in patients with laryngectomy was 20%. Spontaneous closure occurred in 72.73% and 3 patients (27.27%) required the use of flaps. In patients with fistula, 63.64% had previous radiotherapy. In these patients, the use of nasogastric tube feeding lasted > 15 days. Mean length of hospital stay in patients with fistula with 23 days. Conclusion: In our environment, previous radiotherapy was the most significant factor associated with the development of fistula. In these patients, fistula took longer to close and required more complex reconstructions in some cases.

Prognostic impact of second primary tumors in head and neck cancer.

The incidence of Second Primary Tumors in the upper aerodigestive tract varies from 5 to 30 %. Most of them are located either in the same anatomical region or in the lungs, and are related to a poor overall survival. Our objective is to assess the incidence of Second Primary Tumors, factors related to its outcome, frequent associations, and impact on overall survival. 27 patients with Second Primary Tumors were reviewed out of 307 with head and neck cancer, between 2002 and 2011. Patients had a minimum follow-up period of 3 years, or until their death after the last treatment. Sex: 85.2 % were male; male:female ratio of 23:4. The mean age of appearance for the primary tumor was 66.8 years. Only 1 patient had a synchronous Second Primary Tumor, while 26 had metachronous Second Primary Tumors. Second neoplasms were grouped into synchronous and metachronous for statistical analysis. The following parameters were considered: age at diagnosis of the first tumor, gender, smoking and persistence of the habit, primary tumor's location in the larynx, association between two squamous cell carcinomas (index and second primary tumor), and radiotherapy for the primary tumor. The incidence of Second Primary Tumors was 8.79 %. Overall survival of metachronous tumors was 95 months (7.9 years). The primary tumor's location that prevailed when developing a Second Primary Tumor was the larynx. Regarding the histology, the most common association was head and neck squamous cell carcinoma with head and neck squamous cell carcinoma (9 patients). The Second Primary Tumor was the cause of death in 51.9 % of the patients and its most frequent location was the lungs. 19 patients underwent radiotherapy. Second Primary Tumors are common in the head and neck. The authors would like to enforce the importance of an extended follow-up, since second neoplasms worsen considerably the patient's prognosis. Patients who keep on smoking after treatment decrease even more their overall survival.