Pharyngocutaneous fistula following total laryngectomy: multivariate analysis of risk factors

Abstract

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.

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.…”

Free Flap Versus Pedicled Flap Reconstruction of Laryngopharyngeal Defects: A 10‐Year National Surgical Quality Improvement Program Analysis

“…In particular, patients are at risk of pharyngeal stenosis or pharyngocutaneous fistula (PCF) formation, with reported rates ranging from 15.8% to 33% and 10.9% to 34%, respectively. These can lead to prolonged inpatient hospitalization, delayed onset of oral feeding, delayed initiation of adjuvant radiation therapy, and increased overall cost of treatment …”

Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis

“…Patient co-morbidities are consistently identified as a significant risk factor [2, 8, 12, 19, 20]. A systematic review and meta-analysis by Paydarfar and Birkmeyer [8] found prior tracheostomy, pre-operative radiotherapy, a low post-operative haemoglobin and concurrent neck dissection to be associated with higher rates of PCF [8].…”