Raosaheb Rathod1, Prachi S Patil1, Aditya Kale1, Sridhar sundaram, Utkarsh Chhanchure1, Vishal Seth1.
1Department of Digestive Diseases and Clinical Nutrition, TATA Memorial Hospital, Mumbai,India.
Background/Aims: Anastomotic site strictures can develop after post total laryngectomy (TL) performed for head and neck cancer. We performed a retrospective review of a prospectively maintained endoscopy database to evaluate our experience at dilatation of these strictures.
Methods: Included 87 patients underwent stricture dilatation from January 2013 till December 2018. Demographic data and treatment details (type of surgery, types of flaps and anastomotic leak,neoadjuvant therapy(NACTRT), time to stricture, number of dilatation sessions, recurrence and refractory stricture) were noted. Stricture dilatation done using Savary-Gilliard dilators (N=82) and CRE dilators (N=5).
Results: of 87 patients, 79 (90.8%) underwent primary TL,6 (6.89 %) salvage TL while in 2(2.3%) total laryngopharyngectomy done. PMMC patch in 19,jejunal flaps in 4,free flaps in 30 patients were used. Four patients had post-op anastomotic leak. 48 patients (55.1%) received NACTRT. Mean time for development of dysphagia after surgery was 39.3 months. Axis deviation in 13.8 % of patient.Mean sessions for dilatation was 4 (range 1-7) and all strictures are dilated completely (till 14 mm). Stricture recurrence developed in 56 (64.4%) patients at mean duration of 6 months (Range 1-30 months). Complete dilatation was achieved after re-dilatation in 48.21 % (27/56). Refractory strictures was seen in 29 (33.3%) patients.Mean sessions required for complete re-dilatation were 3.2(range 1-6).Complications are seen in 3 patients (perforation 1 and TEP displacement 2). Recurrence of stricture and refractory stricture are more common in patient with PMMC flaps (p=0.002),anastomotic leak and axis deviation (p=0.004). Type of surgery, time to stricture formation, number of initial dilatation sessions,NACTRT were not significantly associated with stricture recurrence.
Conclusion: Post TL strictures are common after surgery. These strictures can be safely dilated using Savary-Gilliard dilators. More than half develops stricture recurrence which can again be treated successfully with re-dilatation. Refractory strictures are common
Keywords: Post TL stricture, Dilatation, Recurrent stricture, Refractory stricture