Delayed oral feeding reduces pharyngocutaneous fistula formation after open surgical treatment of primary hypopharyngeal cancer: A case-control study

Abstract

Objectives Pharyngocutaneous fistula (PCF) formation following open surgical treatment of hypopharyngeal cancer (HPC) is a common and troublesome complication. To date, the postoperative protocol of restarting oral intake is not clear, and vast discrepancies exist in the literature and among institutions. This study aimed to explore the impact of a postoperative protocol of restarting oral intake on PCF formation after open surgical treatment of primary HPC, and its impact on overall survival (OS) and swallowing function based on the functional outcome swallowing scale (FOSS). Materials and Methods This was a prospective observational study of 42 patients who received open surgical treatment for primary HPC at Beijing Friendship Hospital between April 2019 and August 2021. This cohort included two groups: patients who restarted oral intake on the 10th postoperative day (Group 1), and those who started on the 20th (Group 2). The Chi-square test and Fisher’s exact chi-squared test were used for comparing qualitative data among the groups. Results Group 1 (n = 27) and Group 2 (n = 15) were comparable in clinical characteristics. PCF occurred in 7 (25.9%) patients in Group 1, while none occurred in Group 2 ( P = 0.038). The 2-year OS of all 42 patients was 75.6%; 65.8% and 93.3% for Groups 1 and 2, respectively ( P = 0.07). The swallowing function was satisfactory (FOSS Grades 0–III) for 19 (70.4%) patients in Group 1 and 15 (100%) patients in Group 2 ( P = 0.035). Laryngeal preservation was achieved in 25 (59.5%) patients, while decannulation was successful in 22 (88.0%) patients. Conclusions Delayed oral feeding significantly reduces PCF after open surgical treatment of primary HPC, and improves the swallowing function outcome without jeopardizing the OS.

Risk factors and healing factors for pharyngocutaneous fistula after total laryngectomy for laryngeal cancer: An epidemiological study

“…The clinical manifestation of PCF is that saliva is stored in the subcutaneous or incision tissue, forming a purulent cavity that ruptures to the skin or incision edge, allowing the pharyngeal, oesophageal and skin to enter the sinus tract, and through this, saliva or food can overflow to the skin 12,13 . The formation of PCF may be due to the patient's underlying disease, or excessive excision of the pharyngeal mucosa during surgery, resulting in excessive tension during suturing; Either the tight suture leads to mucosal ischaemic necrosis or secondary infection, or the patient has poor wound healing ability after radiotherapy, or improper postoperative diet 14,15 . After the formation of PCF, it can generally self‐heal within 4 weeks.…”

“…If the larger PCF does not heal for more than 4 weeks, it can be repaired surgically 16 . After total resection of laryngeal cancer, it is important to strengthen nutrition, prevent infection and avoid swallowing oral secretions as much as possible to prevent or reduce the formation of PCF 14 …”

“… 12 , 13 The formation of PCF may be due to the patient's underlying disease, or excessive excision of the pharyngeal mucosa during surgery, resulting in excessive tension during suturing; Either the tight suture leads to mucosal ischaemic necrosis or secondary infection, or the patient has poor wound healing ability after radiotherapy, or improper postoperative diet. 14 , 15 After the formation of PCF, it can generally self‐heal within 4 weeks. If the larger PCF does not heal for more than 4 weeks, it can be repaired surgically.…”

Transnasal negative pressure therapy for accelerating healing and improving the prognosis of pharyngocutaneous fistula

“…In most cases, PCF manifests within 2 weeks after TL, 5 resulting in a protracted hospital stay, significant wound care needs, requirement for gastrostomy, and delayed adjuvant therapy 6,7 . Moreover, an unhealed or inadequately healed PCF can have a fatal outcome as a result of sepsis or carotid artery rupture 8,9 . The main problem when treating PCF is that it is hard to close the internal fistula orifice, which is located deep within the pharynx and soaked in saliva.…”

“…6,7 Moreover, an unhealed or inadequately healed PCF can have a fatal outcome as a result of sepsis or carotid artery rupture. 8,9 The main problem when treating PCF is that it is hard to close the internal fistula orifice, which is located deep within the pharynx and soaked in saliva. Therefore, there is a need for more effective treatments for PCF.…”