Postlaryngectomy pharyngocutaneous fistula: Incidence, predisposing factors, and therapy

Objectives: Although organ-preserving radiotherapy or chemoradiotherapy have offered good locoregional control, many patients still experience recurrent disease requiring salvage laryngectomy. The pharyngocutaneous fistulae (PCF) is a common and troublesome complication in the early postoperative period after laryngectomy.Here we evaluated the cause of PCF after laryngectomy, with special emphasis on radiotherapy and/or chemotherapy. Study Design: Retrospective chart review. Methods:

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“…Several reports represent evidences incriminating some of these factors, while others do not arrive at similar conclusions (4,5,6,11,13,14,19).…”

Section: Introductioncontrasting

confidence: 99%

Post-operative pharyngocutaneous fistula after laryngectomy

et al. 2008

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“…Recent studies do not incriminate radiotherapy as a predisposing factor contrary to previous, older research efforts. [5][6][7] Even though much controversy still surrounds the prevention of pharyngocutaneous fistulas, it is generally agreed that most fistulas respond well to conservative management. The differences appear to be mainly related to previous radiotherapy: spontaneous closure was achieved in 44% to 82% of previously treated patients versus 80% to 95% of patients who had not been previously treated.…”

Section: Discussionsupporting

confidence: 87%

The pectoralis myofascial flap in laryngeal surgery

Ozkul¹

2014

J Med Updates

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“…The incidence of PCF was 31% in patients with diabetes and 19.4% in non-diabetics (p=0.302); other additional comorbidities such as chronic pulmonary disease and advanced age were not also found to be related to PCF formation in our study, which is different from what was found in some reports (6,15,29,30). Likewise our study, Akduman et al (31) did not detect any significant relationship between the presence of chronic systemic disease and formation of PCF.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we did not find T 4 stage as a significant risk factor for PCF, in accordance with other studies (1,22,29,33). But some authors (31, 32) declared T 4 stage as a factor significantly associated with PCF formation, in contrary to our study.…”

Section: Discussionmentioning

confidence: 99%

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

Aslıer¹,

Doğan²,

Aslıer³

et al. 2016

Turk Arch Otorhinolaryngol

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Objective: In this retrospective cohort study, we aimed to determine the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) and to define the possible predictors for PCF formation. Methods:The medical records of 198 patients with laryngeal squamous cell carcinoma who underwent TL were reviewed. After the exclusion of patients with history of free flap reconstruction, previous laryngeal surgery, and previous radiotherapy (RT) for other primary cancers, the risk factors for PCF were analyzed in 183 patients who were included in the study. Results:The overall incidence of PCF was 20.2%. A history of heavy smoking and previous RT were detected as independent risk factors in both univariate (p=0.004 and p=0.007, respectively) and multivariate (p=0.005) analyses. Preoperative tracheotomy (PT) longer than 14 days was a risk factor for PCF among patients with PT in the univariate analysis (p=0.031). Overall three-and five-year survival rates were statistically indifferent between the PCF and non-PCF groups (p>0.05). However, the overall five-year survival rate was lesser in the persistent PCF group (47%) than in the non-persistent PCF group (83%) (p=0.038). Conclusion:Heavy smoking and previous RT are independent risk factors for PCF, and the persistence of PCF decreases survival rates. Preventable measures should be taken to decrease the incidence and persistence of this complication of TL in the management of patients with possible risk factors.

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Postlaryngectomy pharyngocutaneous fistula: Incidence, predisposing factors, and therapy

Cited by 151 publications

References 52 publications

Post-operative pharyngocutaneous fistula after laryngectomy

Post-operative pharyngocutaneous fistula after laryngectomy

The pectoralis myofascial flap in laryngeal surgery

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

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