The Role of Pectoralis Major Muscle Flap in Salvage Total Laryngectomy

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Abstract
As a result of the development of organ preservation strategies for patients with advanced laryngeal cancer, initial total laryngectomy (TLR) is now performed mainly in cases involving primary tumors with extensive cartilage invasion or extralaryngeal involvement of soft tissues.1 Patients with poor laryngeal function (incompetent larynx) at the time of diagnosis may also benefit from primary TLR, because functional recovery after nonsurgical treatment is unlikely. In case of tumor persistence or recurrence after primary radiation or chemoradiation treatment, the only remaining option for cure is surgery in the form of salvage partial laryngectomy or TLR.2,3 The type of previous treatment, extent of the tumor, and clinical condition of the patient typically determine the type of surgical procedure that is needed.4 Despite the reproducibility of the surgical technique of TLR, this procedure still involves a high risk for the formation of a postoperative pharyngocutaneous fistula (PCF), especially if it is performed less than 1 year after the primary radiation treatment.5 Traditionally, clinical studies have documented a 10% to 20% incidence of PCF after TLR.6-8 These studies are mainly based on primary TLR. During the last decade, several studies have demonstrated improvement of outcome and a higher rate of larynx preservation after chemoradiation therapy over radiotherapy alone for advanced laryngeal cancer.9,10 Because of this level I evidence, chemoradiation therapy has become the standard of care in eligible patients.11,12 However, the combination of chemotherapy and radiotherapy can result in a higher risk of PCF formation after salvage TLR.13 As a result, an increase in the incidence and severity of PCF has been reported in this population.4,14

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