Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale · 2026
A systematic review of surgical outcomes and postoperative complications based on free flap selection for reconstructing primary or recurrent locally advanced laryngeal-hypopharyngeal tumours.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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De Luca Pietro, Di Stadio Arianna, Abousiam Monir, de Campora Luca, Simone Matteo, Pangallo Sofia, Radici Marco, Calabrese Luca, Benazzo Marco, Camaioni Angelo, Gazzini Luca
Аннотация
OBJECTIVE: To evaluate surgical outcomes and postoperative complications according to free flap selection in patients undergoing reconstruction after total or extended pharyngolaryngectomy for locally advanced (cT3-T4a) laryngeal-hypopharyngeal squamous cell carcinoma (SCC).
METHODS: A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, EMBASE, Cochrane and OVID databases were searched for studies published between 2000 and 2025. Adult patients undergoing partial or circumferential pharyngeal reconstruction with free flap reconstruction were included. Outcomes of interest were flap failure, pharyngocutaneous fistula (PCF), stricture and functional results. Odds ratios (OR) were calculated when feasible.
RESULTS: Twenty-three retrospective studies including 1,849 patients were analysed. The jejunal free flap (JFF) was the most commonly used reconstruction (78%), followed by the anterolateral thigh (ALT) flap (5%). Overall flap survival was high, with total flap necrosis occurring in 2.7% of cases. JFF reconstruction was associated with lower rates of stricture (3.8%) and PCF (3.3%) compared with ALT (9.2% and 5.5%, respectively). ALT reconstruction showed a significantly increased risk of stricture compared to JFF (OR 2.51, p = 0.0002).
CONCLUSIONS: Free flap reconstruction after pharyngolaryngectomy is reliable, with high flap survival rates. The JFF remains associated with lower rates of luminal complications, particularly in circumferential defects, while the ALT flap represents a valid alternative. Flap selection should be individualised, and further prospective studies with standardised outcomes are warranted.
METHODS: A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, EMBASE, Cochrane and OVID databases were searched for studies published between 2000 and 2025. Adult patients undergoing partial or circumferential pharyngeal reconstruction with free flap reconstruction were included. Outcomes of interest were flap failure, pharyngocutaneous fistula (PCF), stricture and functional results. Odds ratios (OR) were calculated when feasible.
RESULTS: Twenty-three retrospective studies including 1,849 patients were analysed. The jejunal free flap (JFF) was the most commonly used reconstruction (78%), followed by the anterolateral thigh (ALT) flap (5%). Overall flap survival was high, with total flap necrosis occurring in 2.7% of cases. JFF reconstruction was associated with lower rates of stricture (3.8%) and PCF (3.3%) compared with ALT (9.2% and 5.5%, respectively). ALT reconstruction showed a significantly increased risk of stricture compared to JFF (OR 2.51, p = 0.0002).
CONCLUSIONS: Free flap reconstruction after pharyngolaryngectomy is reliable, with high flap survival rates. The JFF remains associated with lower rates of luminal complications, particularly in circumferential defects, while the ALT flap represents a valid alternative. Flap selection should be individualised, and further prospective studies with standardised outcomes are warranted.