The objective of this study is to establish the role of risk factors in the etiology of pharyngocutaneous fistula formation after total laryngectomy. A retrospective study was performed for patient, disease and treatment-related factors, and also factors related to pathology specimen. Logistic regression analysis revealed that fistula development ratio was 4.955 times higher in patients with fistula than in the control group when the preoperative hemoglobin value was below 12.2 g/dL, 3.653 times higher when the postoperative hemoglobin value was below 12.2 g/dL, 3.471 times higher in the presence of an accompanying systemic disease, 3.23 times higher when the postoperative albumin level was below 3.5 g/dL, 3.1 times higher when ipsilateral lymph node was positive, 2.05 times higher when erythrocyte suspension is used as transfusion material, and 1.048 times higher when contralateral lymph node was positive. Proper concomitant systemic disease control, maintenance of hematologic values in the pre- and postoperative periods, provision of adequate nutrition, preference of erythrocyte suspensions for transfusion are the key points for the prevention of pharyngocutaneous fistula development. Preoperative detection of positive cervical lymph nodes should alert the physician about the potential development of fistula.