Pharyngocutaneous Fistula Incidence After PMMC Patch Pharnygoplasty for Post Laryngectomy Defect Reconstruction – Predictive Factors, Our Experience at KMIO

Abstract

To analyse pharyngocutaneous fistula, post Pectoralis major myocutaneous patch pharnygoplasty, and its association with various tumor, patient and treatment related factors. It is a retrospective study that included 48 patients who underwent laryngectomy and PMMC patch pharyngeal reconstruction from year 2009 to 2013. We studied the previously reported factors that could influence fistula formation such as age, gender, previous radiotherapy, previous tracheostomy, location of tumor, extent of tumor, tumor volume, tumor stage and surgical margins. Pharyngocutaneous fistula was observed in 13(27.1 %) cases. In 84.6 % (n=11) patients, fistula closure was achieved by conservative measures. No statistically significant association was found between tumor location, extent and size. There was no association between history of previous tracheostomy and postoperative microscopic margin status. Patients with T4 disease showed increased association (36.7 %) compare to T3 stage (11 %) (p value-0.0362). Postoperatively 6 patients presented with dysphagia out of which 4 patients (66.7 %) had history of leak. It also showed significant increase in post operative stay and delay in oral feeding in fistula patients. There is still no consensus regarding the most significant risk factors, our data showed that, most disease and treatment related parameters were not predictive for fistula occurence. Prabably a larger number of patient cohart need to be analysed for additional information.

Management of postreconstructive head and neck salivary fistulae: A review of current practices

“…A total of 1156 studies were further narrowed down to 19 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] peer-reviewed publications, for a total of 132 patients ( Table 1) pharyngocutaneous fistulas (3.1%) were complicated by carotid blowout. (Table 2) Most salivary fistulas could be diagnosed clinically.…”

“…However, 2 separate retrospective studies found no statistically differences in terms of choice of treatment between their fistula patients with and without radiotherapy exposure 14,17 .…”