Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jul 24, 2025; 16(7): 109246
Published online Jul 24, 2025. doi: 10.5306/wjco.v16.i7.109246
Closure techniques for esophageal reconstruction after total laryngectomy and their impact on fistula formation
Adam Galazka, Katarzyna Stawarz, Karolina Bienkowska-Pluta, Monika Paszkowska, Magdalena Misiak-Galazka
Adam Galazka, Katarzyna Stawarz, Karolina Bienkowska-Pluta, Monika Paszkowska, Department of Head and Neck Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Mazowieckie, Poland
Magdalena Misiak-Galazka, Department of Dermatology, Maria Sklodowska-Curie Medical Academy, Evimed Medical Center Ltd., Warsaw 00-136, Mazowieckie, Poland
Magdalena Misiak-Galazka, Department of Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Mazowieckie, Poland
Author contributions: Galazka A, Paszkowska M, and Bienkowska-Pluta K contributed to the conceptualization and investigation; Galazka A and Stawarz K contributed to the formal analysis; Galazka A, Paszkowska M, Misiak-Galazka M, and Stawarz K contributed to the methodology; Galazka A and Stawarz K contributed to writing—the original draft; Galazka A, Paszkowska M, Misiak-Galazka M, Bienkowska-Pluta K, Stawarz K contributed to writing—review and editing; Paszkowska M and Pluta K contributed to the supervision; Misiak-Galazka M and Stawarz K contributed to the investigation; Bienkowska-Pluta K contributed to the data curation, and visualization.
Institutional review board statement: The Ethics Committee of the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, waived the need for ethics approval and patient consent for the collection, analysis and publication of the retrospectively obtained and anonymized data for this study. The study involved the retrospective collection, analysis, and publication of anonymized data from a non-interventional study.
Informed consent statement: Patients were not required to provide additional informed consent for this study, as the analysis was conducted using anonymized clinical data collected after each patient had provided written consent for treatment. All participants gave informed written consent as part of the standard procedure prior to undergoing treatment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items—and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: All data supporting the findings of this study are available upon reasonable request from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Katarzyna Stawarz, MD, PhD, Department of Head and Neck Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, W.K.Roentgen 5, Warsaw 02-781, Mazowieckie, Poland. katarzyna.stawarz@coi.pl
Received: May 6, 2025
Revised: May 21, 2025
Accepted: June 19, 2025
Published online: July 24, 2025
Processing time: 78 Days and 22.7 Hours
Abstract
BACKGROUND

The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures. While voice prostheses have significantly improved post-laryngectomy rehabilitation, the risk of salivary fistula remains a major complication. This study aims to compare the stapler and hand-sewn techniques for esophageal closure and evaluate their impact on fistula formation.

AIM

To compare stapler-assisted and hand-sewn esophageal closure techniques after laryngectomy regarding their impact on salivary fistula formation.

METHODS

A total of 52 patients (44 men, 8 women), aged 43 to 77 years, underwent total laryngectomy. Esophageal reconstruction was performed using either a stapler (29 patients) or a hand-sewn technique (23 patients). A surgical stapler TA was used for esophageal closure in the stapler group. Patients were clinically monitored for fistula formation during the first 7 days postoperatively and again two weeks after discharge using fiberoptic examination.

RESULTS

A total of 22 salivary fistulas were recorded: 17 (77.3%) occurred following the hand-sewn technique, while 5 (22.7%) developed in the stapler group. Additionally, preoperative radiotherapy was identified as a statistically significant risk factor for fistula formation. No technical complications related to the stapler device were observed.

CONCLUSION

Although hand-sewn closure is commonly used after total laryngectomy, stapler-assisted closure shows lower fistula rates and is a viable esophageal reconstruction alternative.

Keywords: Laryngeal cancer; Total laryngectomy; Surgical stapler; Radiotherapy; Salivary fistula

Core Tip: This study compares stapler-assisted and hand-sewn techniques for esophageal closure after total laryngectomy, focusing on salivary fistula formation. Stapler-assisted closure significantly reduced fistula incidence (22.7% vs 77.3%) without technical complications, highlighting it as a safe and effective alternative to the traditional hand-sewn method. Preoperative radiotherapy was identified as a significant risk factor for fistula development. These findings suggest stapler-assisted closure may improve postoperative outcomes and should be considered in surgical planning for laryngectomy patients.