(0648) Flap or No Flap: Comparison of Total Laryngectomy Reconstruction Techniques on Neopharyngeal Stenosis Outcomes

Introduction: Total laryngectomy (TL) remains the standard of care for advanced stage or recurrent disease. Common neopharyngeal complications from TL surgery include stricture, dysphagia, and fistula which can be difficult to manage. We present the first systematic review comparing the outcomes of all reconstructive flap techniques to primary closure (PC) following TL and total pharyngolaryngectomy (TPL) and their rates of associated complications.

Methods: A systematic review and meta-analysis of TL outcomes was performed. PubMed, Scopus, and ProQuest databases were searched from July 2023. Inclusion criteria included prospective studies, case series, and retrospective chart reviews reporting on neopharyngeal stenosis following flap reconstruction or primary closure of TL. We excluded non-English articles and articles published after 2000. Two reviewers independently screened titles and abstracts from 1,855 articles, while a third reviewer settled any discrepancies. The selected primary outcomes included pharyngoesophageal stricture and need for neopharyngeal dilation, dysphagia, and fistula formation. A total of 70 unique studies were selected for review and statistical analysis, including 38 flap articles, 9 PC articles, and 23 articles pertaining to both.

Results: There were 61 flap and 32 PC-related total laryngectomy studies investigated for outcomes, which resulted in the inclusion of 2,881 flap patients and 2,522 PC patients. Analysis of selected outcomes demonstrates a greater frequency of dilation and fistula in PC patients. Fistula was significantly more likely following primary closure (p = 0.01), while dysphagia was more common after flap reconstruction (p = 0.03). Rates of stricture were similar between groups at 20% and 18% for flap and PC patients, respectively.

Conclusions: Flap reconstruction is associated with lower rates of fistula, but higher rates of dysphagia compared to PC. Surgeons should be aware of the complication rates for post-TL reconstructive techniques and further research is needed to improve outcomes.