Pharyngo-cutaneous fistula formation following total laryngectomy: management, sequelae and outcomes

Abstract

Objective: To describe our experience of dealing with pharyngocutaneous fistulas (PCF) following total laryngectomy. Design:Retrospective cohort Setting: Tertiary referral center Participants: All patients undergoing total laryngectomy at the [removed for blind peer review] over the 10 year period January 2008 to December 2017. Main outcome measures: Incidence of PCF; treatment of PCF (conservative versus operative), closure success rate; time to closure; delay in adjuvant radiotherapy; increased the need of future neopharyngeal dilatations; overall survival. Results: A total of 242 patients (199 males, 43 females) were analysed. One hundred and fifteen patients underwent primary laryngectomy, 102 salvage laryngectomy and 25 functional laryngectomy. Seventy five of 242(31%) patients had a PCF. This was managed conservatively in 36/75 (48%) and operatively in 39/75 (52%) . Hospital length of stay was significantly longer in the PCF group (OR 2.38, p=<0.001). 5 year overall survival was 44% in the no PCF versus 24% in the PCF group, OR 1.7, p=0.001. PCF was not correlated with delay to adjuvant radiotherapy or the risk of neopharyngeal dilatation. Conclusions: Despite efforts to identify risk factors and take preventive measures, PCF remains an all to frequent complication of total laryngectomy. PCF leads to increased morbidity and significantly worse overall survival. The increased mortality is not a result of a delay in adjuvant radiotherapy. Key points• Pharyngo-cutaneous fistula (PCF) occurred in 31% of cohort of 242 patients • 81% of PCFs ultimately healed • 52% of PCFs underwent at least 1 operation • PCF was not associated with a delay in adjuvant radiotherapy nor increased risk of future dilatation • PCF is associated with a significantly worse 5 year overall survival (44% vs 24%, , OR 1.7, p=0.001)