Comparison of pharyngocutaneous fistula between patients followed by primary laryngopharyngectomy and salvage laryngopharyngectomy for advanced hypopharyngeal cancer

Abstract

Preoperative radiation therapy and hypo-albuminemia increase the fistula rate significantly. A prolonged hospital course was noted among all fistula patients.

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).…”

“…Although this opinion has many justifications, the early primary surgical closure of an existing PCF is not always easy and successful. According to our experience, as some PCFs spontaneously close with appropriate treatment, our initial approach was conservative treatment, as reported in other studies (7,13,14). However, if 2 weeks of conservative treatment fails, surgical intervention is required to attempt to close the fistula.…”

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

“…Pharyngocutaneous fistula development is a common complication of total laryngectomy resulting in increased length of hospital stay [8,10–12], delayed oral intake [12,29], delay of adjuvant therapy [26] and often the need for complex wound care and additional procedures for fistula closure [11,12]. Given the frequency of PCF and its significant morbidity, it is important to identify salient risk factors and potential measures for improving outcomes.…”

“…The most frequent postoperative complication is the development of a pharyngocutaneous fistula (PCF), which occurs with variable frequencies of 3% to 65% in reported series, most falling within 10%–40% [7]. PCF is an early complication [8,9] that causes increased length of hospital stay and delayed initiation of oral diet, and requires complex wound care, occasionally necessitating additional surgery for closure [8,10–12]. …”

“…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.…”