Pharyngeal Mucosal Margin Vessel Counts Predict Pharyngocutaneous Fistula in Salvage Laryngectomy

Andrew D P Prince; Molly E Heft Neal; Marisa R Buchakjian; Steven B Chinn; Chaz L Stucken; Keith A Casper; Kelly M Malloy; Mark E P Prince; Andrew J Rosko; Jonathan B McHugh; Matthew E Spector

doi:10.1002/ohn.865

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Pharyngeal Mucosal Margin Vessel Counts Predict Pharyngocutaneous Fistula in Salvage Laryngectomy

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Pharyngeal Mucosal Margin Vessel Counts Predict Pharyngocutaneous Fistula in Salvage Laryngectomy

Andrew D P Prince, Molly E Heft Neal, Marisa R Buchakjian, Steven B Chinn, Chaz L Stucken, Keith A Casper, Kelly M Malloy, Mark E P Prince, Andrew J Rosko, Jonathan B McHugh, …

Otolaryngology-head and neck surgery, Vol.171(3), pp.785-790

09/2024

DOI: 10.1002/ohn.865

PMID: 38881401

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Abstract

OBJECTIVE We evaluated vessel counts in the pharyngeal mucosal margins of patients who underwent salvage laryngectomy to establish whether mucosal vascularity might predict fistula risk.STUDY DESIGN Retrospective cohort.SETTING Tertiary Medical Center. METHODS Patients who underwent salvage total laryngectomy at our institution between 1999 and 2015 were identified. Pharyngeal mucosal margins from laryngectomy specimens were evaluated histologically for each patient, and vessel counts were performed on 5 ×10 images. The primary outcome measure was fistula within 30 days of surgery and mean vessel counts were assessed as the principle explanatory variable.RESULTS Seventy patients were included and 40% developed a postoperative fistula. There was a large difference in the mean vessel count in patients who did develop fistula (48.6 vessels/×10 field) compared to those who did not (34.7 vessels/×10 field). A receiver operative characteristic curve found that a cutoff value of 33.9 vessels/×10 field provided a sensitivity of 75% and specificity of 62% to predict the likelihood of fistula occurrence (area under the curve = 0.71, 95% confidence interval [CI]: 0.59-0.83). In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula (95% CI: 1.8-16.45). Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized.CONCLUSION After salvage laryngectomy, patients with higher mean mucosal margin vessel counts are at increased risk of fistula. The mechanism is unknown, but the disorganization of the vasculature may contribute to poor wound healing. Vessel counting may allow for fistula risk stratification and guide postoperative care.

Details

Title: Subtitle: Pharyngeal Mucosal Margin Vessel Counts Predict Pharyngocutaneous Fistula in Salvage Laryngectomy
Creators: Andrew D P Prince - Michigan Medicine
Molly E Heft Neal
Marisa R Buchakjian - University of Iowa
Steven B Chinn - Michigan Medicine
Chaz L Stucken - Michigan Medicine
Keith A Casper - Michigan Medicine
Kelly M Malloy - Michigan Medicine
Mark E P Prince
Andrew J Rosko - ProMedica
Jonathan B McHugh - University of Michigan
Matthew E Spector - University of Pittsburgh
Resource Type: Journal article
Publication Details: Otolaryngology-head and neck surgery, Vol.171(3), pp.785-790
DOI: 10.1002/ohn.865
PMID: 38881401
NLM abbreviation: Otolaryngol Head Neck Surg
eISSN: 1097-6817
Language: English
Electronic publication date: 06/17/2024
Date published: 09/2024
Academic Unit: Otolaryngology
Record Identifier: 9984643650502771

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