Surgical prevention of pharyngocutaneous fistula in salvage total laryngectomy: a systematic review and network meta-analysis

Purpose To compare the efficacy of different reconstructive techniques in preventing pharyngocutaneous fistula (PCF) after salvage total laryngectomy (STL). Methods An arm-based network analysis was conducted using a Bayesian hierarchical model according to the PRISMA-NMA guidelines. Results A total of 1694 patients with a median age of 64 years (n = 1569, 95% CI: 62–66 years) were included. If compared to primary pharyngeal closure alone, only a pedicled flap onlay (PFO) showed a statistically significant reduction in PCF rate (OR: 0.35, CI: 0.20–0.61). PFO seemed to perform better than other treatments according to the rank probabilities test (39.9% chance of ranking first). Conclusions A pedicled flap placed with an overlay technique might be preferred over a patch reconstruction to prevent PCF after STL.