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

Abstract

Purpose The purpose of this study was to determine the incidence of and risk factors for pharyngocutaneous fistula in patients undergoing total laryngectomy at a single institution. Materials and methods The records of 59 patients undergoing primary or salvage total laryngectomy at our institution from 2001 to 2012 were retrospectively reviewed. Data collected included patient, tumor and treatment characteristics, and surgical technique. Risk factors were analyzed for association with pharyngocutaneous fistula formation. Results Twenty patients (34%) developed fistulas. Preoperative tracheostomy (OR 4.1; 95% CI 1.3–13 [p = 0.02]) and low postoperative hemoglobin (OR 9.1; 95% CI 1.1–78 [p = 0.04]) were associated with fistula development. Regarding surgical technique, primary sutured closure of the total laryngectomy defect had the lowest fistula rate (11%). In comparison, primary stapled closure and pectoralis onlay flap over primary closure had nonsignificantly increased fistula rates (43%, OR 6.0; 95% CI 1.0–37.3 [p = 0.06] and 25%, OR 2.7; 95% CI 0.4–23.9 [p = 0.38], respectively). Pectoralis flap incorporated into the suture line had a significantly increased fistula rate (50%, OR 7.1; 95% CI 1.4–46 [p = 0.02]). After stratification for salvage status, patient comorbidities were associated with fistula in non-salvage cases whereas disease-related characteristics were associated with fistula in salvage cases. Fistula development was associated with increased length of hospital stay (p < 0.001) and increased time before oral diet initiation (p < 0.001). Conclusions Pharyngocutaneous fistula is a common complication of total laryngectomy. Preoperative tracheostomy, postoperative hemoglobin, and surgical technique are important in determining the risk of fistula.

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

“…In a recent study, Benson et al (5) reported the incidence as 34%. Our incidence of PCF (20.2%), which is still high, lies within the mid-range of previous series (1,(5)(6)(7)(8).…”

“…Supraglottic tumors were speculated to be a risk factor as they require extensive resections and complicate pharyngeal reconstruction (3,14). This finding was not verified in our study as was done in other studies (5,17).…”

“…In a recent systematic literature review, chronic obstructive pulmonary disease, previous hemoglobin levels<12. 5 kept within normative ranges in our patients. The impacts of prophylactic antibiotherapy on PCF development were also not also analyzed as all patients received the same approach for the management.…”

Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review

“…Sixteen articles potentially fit for inclusion in the review were selected . Of these, 4 were excluded after a complete reading: the first was excluded because it did not provide data regarding the incidence of pharyngocutaneous fistula separately between the groups submitted to primary and salvage laryngectomy; the second article referred to the surgical technique description, with no comparative data; the third article presented a case series of patients already mentioned in another study included in this review; in the fourth article, various types of surgical flaps were used precluding the use of data on the PMMF . Thus, this review included data from 12 observational retrospective studies, including 742 patients (253 in the PMMF group and 489 in the control group; Figure ).…”

Defining the low‐risk salvage laryngectomy—A single‐center retrospective analysis of pharyngocutaneous fistula

“…Other positive predictors have included performance of concurrent neck dissection, advanced tumor size, positive surgical margins, low postoperative hemoglobin, and preoperative tracheostomy …”