Complications in Head and Neck Surgery

Abstract

Objective: To summarize the potential risk factors for postlaryngectomy pharyngocutaneous fistula.Data Sources: Observational studies in the Englishlanguage literature about postlaryngectomy pharyngocutaneous fistula from January 1, 1970, to March 31, 2003 Studies were identified through a MEDLINE search with relevant key words; additional studies were identified through references. Study Selection:We included studies about the site of primary malignancy, type of procedure, and type of closure; studies had to have been based on individuallevel data, with a comparison group for each risk factor evaluated.Data Extraction: Data required to calculate the relative risk of fistula associated with commonly reported risk factors were abstracted from the studies, and a meta-analysis using a random-effects approach was performed to estimate a summary relative risk of fistula for each risk factor. The statistical signifi-cance of heterogeneity of effects among studies was assessed. Data Synthesis:Of 65 studies identified, 26 met the inclusion criteria. Significant risk factors identified in the pooled analysis included postoperative hemoglobin level less than 12.5 g/dL, prior tracheotomy, preoperative radiotherapy, and preoperative radiotherapy and concurrent neck dissection. The degree of heterogeneity of effects among studies was significant for postoperative hemoglobin level, preoperative radiotherapy, concurrent neck dissection, and comorbid illness. The severity of fistula was greater in patients with a history of radiotherapy.Conclusions: This meta-analysis identified several significant risk factors for postlaryngectomy pharyngocutaneous fistula. The clinical implications of these findings and the potential sources of heterogeneity of effects among studies are discussed.

Perioperative Factors Aggravating Pharyngocutaneous Fistula After Total Laryngectomy

“…Our findings corroborate those of previous reports, supporting the idea that PCF formation is associated with postoperative anemia. [1][2][3][4][5][11][12][13][14] Interestingly, unlike previous reports, we found no significant differences regarding age, smoking history, or history of lifestyle-related diseases (eg, liver diseases) between patients with and those without PCFs. This discrepancy may be due to differences in patient characteristics among institutions or population bias.…”

“…Therefore, we performed a logistic regression analysis adding total operative time as an indicator of the surgeon's skill and found that both prior treatment and total operative time were risk factors for PCF formation (Table 4). Our findings corroborate those of previous reports, supporting the idea that PCF formation is associated with postoperative anemia 1–5,11–14 . Interestingly, unlike previous reports, we found no significant differences regarding age, smoking history, or history of lifestyle-related diseases (eg, liver diseases) between patients with and those without PCFs.…”

Pharyngocutaneous fistula after total laryngectomy: Prevalence and risk factors

“…Our observed rate of PCF of 17.5% is consistent with previous reports in the literature [ 13 ]. Pharyngectomy and postoperative infection were identified as independent risk factors while cardiovascular disease, preoperative hemoglobin <110 g/L, prior RT/CRT, tracheostomy, salvage surgery, neck dissection and the use of a pectoral flap only were significant in the univariate analysis.…”

Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: Analysis of a large multi-institutional patient cohort

“…Of the 917 patients included in this study, 50 (5.1%) developed PCF. This falls within the classically quoted 3–65% range in literature [ 2 ]. It is, however, lower than rates identified in recent single-institution studies, which have been in the 30–35% range [ 4 – 6 ].…”

“…The second risk factor for PCF identified in the overall group was transfusion of more than 4 units of PRBCs within 72 h pre-operatively. This is consistent with systematic review findings that transfusion and anemia (HGB < 125 g/L) are significant risk factors [ 1 , 2 , 7 ]. Of note, while pre-operative transfusion was correlated with PCF in our study, peri- and post-operative transfusion were not found to be significantly so.…”