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Pharyngo‐cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole
Author(s) -
Johansen Lars Vendelbo,
Overgaard Jens,
Elbrønd Ole
Publication year - 1988
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19880215)61:4<673::aid-cncr2820610410>3.0.co;2-c
Subject(s) - medicine , laryngectomy , radiation therapy , surgery , complication , fistula , metronidazole , incidence (geometry) , larynx , antibiotics , physics , optics , microbiology and biotechnology , biology
The development of a pharyngocutaneous fistulae is a major complication after total laryngectomy. In Denmark radiotherapy is the primary treatment for all laryngeal carcinomas. Based on the experience with conventional daily irradiation, a split‐course radiation schedule was introduced in 1978. The charts of 106 consecutive patients laryngectomized for recurrence in the years 1975 to 1984 were examined. Thirty‐four patients developed a fistula. An evaluation of the different radiotherapy schedules used during this period allowed a dose‐response curve to be constructed. It showed a pronounced increase of fistulae with high doses of radiotherapy. Split‐course radiotherapy caused a rise in late complications and did not improve tumor control. Large field sizes increased the number of fistulae. High‐dose fractions showed a surprisingly high incidence of late complications. Prophylactic metronidazole (introduced in 1980) resulted in a highly significant decrease in the frequency of postoperative fistulae. Patients in whom fistula formed were hospitalized for an average of 54 days, patients without, for 22 days.