Pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis of risk factors

Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction

“…Bothersome pharyngocutaneous fistulas are well‐known complications to the reconstruction of the neopharynx, with or without flaps. A recent meta‐analysis involved fistula frequency after laryngectomy between 7.8% and 58.0% . In the present case, multiple fiber endoscopies showed vital FAMM island flap surface and no visible defect in the flap area, thus, the fistula was possibly arising from anywhere along the suture lines and not attributable to the flap specifically.…”

Evidence and evidence gaps of laryngeal cancer surgery

“…From a methodical point of view, it must be criticized that most of the studies included in the meta-analyses had only low case numbers and in most cases no multivariate statistical analyses were performed. All 3 meta-analyses concur that the condition after preoperative radiotherapy and the presence of a pre- or postoperative hemoglobin value <12.5 g/l is associated with an increased risk to develop pharyngocutaneous fistulas [221], [222], [223]. Additionally, at least one of the meta-analyses could show that the diagnosis of COPD, present tracheostomy, necessity of blood transfusion, supraglottic tumor location, hypopharyngeal cancer, advanced primary tumors, positive resection margins, and simultaneous neck dissection are associated with a higher incidence of pharyngocutaneous fistulas after total laryngectomy [221], [222], [223].…”

“…The incidence after total laryngectomy varies in different studies between 3% and 65% [177]. In 3 meta-analyses the main risk factors for the occurrence of pharyngocutaneous fistulas were analyzed [221], [222], [223]. From a methodical point of view, it must be criticized that most of the studies included in the meta-analyses had only low case numbers and in most cases no multivariate statistical analyses were performed.…”

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

“…Salvage total laryngectomy (STL) describes a laryngectomy performed following previous curative intent radiation therapy with or without chemotherapy. Paydarfar et al and Liang et al highlighted the greater than two‐fold increased risk in PCF with STL. This can be understood when considering the altered microvascular structure of irradiated tissue that negatively impacts wound healing…”