Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy.
OBJECTIVE
The pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy, and its etiology is not well understood yet. The aim of our study was to evaluate predisposing factors, incidence, and management of this complication.


METHODS
This was a retrospective study of 268 patients who underwent total laryngectomy in our clinic (January 1990-December 2001). A number of factors potentially predisposing to PCF formation were evaluated.


RESULTS
A PCF was observed in 16% of patients. Systemic diseases, previous radiotherapy, supraglottic origin of tumor, and concurrent radical neck dissection were significantly associated with PCF. Spontaneous closure was noted in 28 patients, whereas a surgical closure was necessary in 15 patients.


CONCLUSIONS
In presence of a specific risk factor, PCF can be expected; nevertheless, its prevention remains very difficult. Moreover, given the high percentage of spontaneous closure, we suggest the "wait and see" approach for 28 days before proceeding with a surgical approach.


METHODS
C.
Galli
Jacopo
J
Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy.
De Corso
Eugenio
E
Volante
Mariangela
M
Almadori
Giovanni
G
Paludetti
Gaetano
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D017577:Cutaneous Fistula / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome