Assessment and incidence of salivary leak following laryngectomy

Abstract

Objectives/Hypothesis To determine the incidence and risk factors of pharyngocutaneous fistula formation in patients undergoing either primary or salvage laryngectomies and evaluate the role of barium esophagram in these patients. Study Design Retrospective cohort study. Methods Medical records of 259 patients who underwent total laryngectomy between 2003 and 2009 at our institution were reviewed. Risk factors for fistula formation were analyzed, including primary treatment modality, comorbidities, and operative details, which included use of a free flap for closure, concurrent neck dissections, margin status, and preoperative tracheostomy. The length of time until leak, postoperative swallow study results, and fistula management strategies were also assessed. Results Fifty-five patients developed a pharyngocutaneous fistula (overall incidence, 21%) in a median time of 12 days (range, 4–105 days). Twenty of these patients underwent laryngectomy as their initial treatment modality, and 35 had failed previous radiotherapy. Fistula formation was significantly higher in salvage surgery patients (P = .03), particularly those with hypothyroidism (P < .0002). A barium swallow performed at approximately 1 week after laryngectomy demonstrated a sensitivity of 26% with a specificity of 94%. Sixty-two percent of the fistulas healed with conservative measures only. Conclusions Our data confirmed that previous radiotherapy and hypothyroidism, particularly in salvage laryngectomy patients, are important significant predictors of postoperative pharyngocutaneous fistula. The use of a postoperative barium swallow in these patients may be useful but was not found to be highly sensitive in predicting who will develop a clinically evident leak and should be used with caution.

Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking

“…In our study, we demonstrated an increased incidence of PCF in patients with preoperative RT, which is in agreement with the majority of literature reports (13)(14)(15)(16)(17)(18)(19)(20). While, some studies did not find any association between preoperative RT and PCF formation (5-7, 21, 22).…”

Pharyngocutaneous fistula after total laryngectomy: A single-institution experience, 2001–2012

“…This has been reported in other studies [22,23] and also in a meta-analysis [7], and there is speculation that it may be secondary to tissue contamination and/or larger tumor size [22]. We also identified hypothyroidism and low postoperative hemoglobin as risk factors for PCF, which have consistently been reported in other studies [7,13,14,19,23]. …”

“…Preoperative radiation therapy increases both the frequency and severity of postoperative PCF [3,4,10,13–15], and chemotherapy augments this effect [3,16,17]. Other factors associated with increased rates of PCF include patient comorbidities [8,10,18], hypothyroidism [13], low perioperative hemoglobin [7,19,20] and albumin [10,19], more advanced primary tumor stage [21], prior tracheotomy [7,22,23] positive surgical margins [24,25], concurrent neck dissection [7,15,18], shorter elapsed time from completion of radiation to surgery [15], and surgical closure technique [10,12,26]. Although it is generally accepted that previous radiation and chemoradiation increase the risk of PCF [27], there is little consensus regarding the relative significance of these other various factors.…”

Pharyngocutaneous Fistula Incidence After PMMC Patch Pharnygoplasty for Post Laryngectomy Defect Reconstruction – Predictive Factors, Our Experience at KMIO

“…A recent review by White HN et al [13] showed pharyngocutaneous fistula overall incidence of 21 %. Their data confirmed previous radiotherapy and hypothyroidism, particularly in salvage laryngectomy patients, as important significant predictors of postoperative pharyngocutaneous fistula.…”