The use of stapler for pharyngeal closure after total laryngectomy

PURPOSE: To evaluate total laryngectomy for the surgical salvage after a unsuccessful chemoradiation therapy treatment for advanced laryngeal squamous cell carcinoma. METHODS: Twelve total laryngectomies were performed from March, 2001 to December, 2002 for recurrence salvage using the linear stapler for pharyngeal closure. The organ preservation protocol for advanced laryngeal cancer consists in weekly cysplatin concomitant to the radiation therapy. The age ranged from 42 to 64 and 11 patients were men. A new clinical stage analysis was performed with telelaryngoscopy, suspension laryngoscopy under general anesthesia and computed tomography. The recurrences should be restricted to the endolarynx. The linear stapler was applied longitudinally in the vallecula between the pharynx and larynx as close as possible to the thyroid cartilage alae. The primary placement of the phonatory prosthesis was performed in 11 patients after the pharyngeal closure. All the patients were discharged from the 4th to the 10th postoperative day and the oral intake was started in the 10th postoperative day. The pharyngeal and esophageal contrasted radiography was performed from the 21th to the30th postoperative day in order to evaluate the pharyngeal pouch. RESULTS: The stapler placement delayed no more than five minutes. There was no report of infection, pharyngocutaneous fistulae, dysphagia complaint and pharyngoesophageal narrowing on the radiographic examination. The phonatory prosthesis was succfully used for the speech rehabilitation. CONCLUSION: The use of the stapler is technically easy to perform and it does not increase the rate of fistulae and dysphagia in patients underwent salvage laryngectomy after radiation therapy. The surgical time is reduced and the primary phonatory rehabilitation with tracheoesophageal prosthesis is feasible.

Laryngectomy; Pharynx; Laryngeal neoplasms; Surgical clips

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