Vascular Density Predicts Fistula Risk in Salvage Laryngectomy: Study

For this purpose, the researchers conducted a retrospective cohort study at a tertiary medical center. They identified patients who underwent salvage total laryngectomy at their institution between 1999 and 2015. For each patient, pharyngeal mucosal margins from laryngectomy specimens were histologically evaluated, and vessel counts were performed on 5 ×10 images.

The main outcome measure evaluated was the occurrence of fistula within 30 days following surgery, with mean vessel counts analyzed as the primary explanatory factor.

The following were the key findings of the study:

• 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 a 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).
• In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula.
• Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized.

The findings showed that patients with higher mean mucosal margin vessel counts are at increased risk of fistula after salvage laryngectomy.

"The precise mechanism remains unclear, but vascular disorganization is theorized to play a role in impaired wound healing. Counting vessels could aid in stratifying the risk of fistula development and inform postoperative care strategies," the researchers wrote.

Reference:

Prince ADP, Heft Neal ME, Buchakjian MR, Chinn SB, Stucken CL, Casper KA, Malloy KM, Prince MEP, Rosko AJ, McHugh JB, Spector ME. Pharyngeal Mucosal Margin Vessel Counts Predict Pharyngocutaneous Fistula in Salvage Laryngectomy. Otolaryngol Head Neck Surg. 2024 Jun 17. doi: 10.1002/ohn.865. Epub ahead of print. PMID: 38881401.