(A599) Platelet-rich Fibrin in Upfront Total Laryngectomy and Pharyngocutaneous Fistula: A Systematic Review and Meta-Analysis

Introduction: Pharyngocutaneous fistula (PCF) is a well-known complication following total laryngectomy (TL). It has been shown to increase mortality, morbidity, hospital stay, delay in adjuvant treatment and length of feeding tube dependence. Multiple efforts have been made to decrease the incidence of PCF following TL, such as tension-free closure, multilayer closure, adequate preoperative nutrition and thyroid function to mount a robust healing response. PRF has been shown to improve healing in various tissues. It is affordable and easy to procure. Recent studies have proposed the application of PRF to reduce PCF formation following upfront TL.

Methods: A systematic review and meta-analysis was conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 37 total studies were identified across Pubmed, Embase, Scopus, CENTRAL and Web of Science databases from inception to December 2024. 3 studies were included in the review. Data was analyzed using a meta-analysis of odds ratio with the Mantel-Haenszel model and a fixed effects model due to low heterogeneity.

Results: A total of 155 patients undergoing upfront TL were included in the study. 78 patients were included in the PRF arm compared to 77 patients in the control arm (standard closure with no PRF application). Follow-up time ranged from 5 to 30 days across studies. The incidence of PCF was found to be significantly reduced in the PRF groups (OR= 0.13, 95% CI [0.08; 0.38], I2= 0%, p< 0.01). On evaluation of secondary outcomes, the average length of hospital stay, postoperative pain and edema were significantly lower in the PRF group. Additionally, there was an inverse correlation between low albumin and hemoglobin levels and a higher PCF incidence.

Conclusions: PRF shows great potential in reducing the incidence of PCF in patients undergoing upfront TL. Additional studies are needed. Firstly, longer follow-up times are needed to ensure the oncologic safety of PRF application in the oncologic surgical field. Secondly, exploration of the application of PRF to radiated tissue is necessary in the setting of a salvage laryngectomy.