Prediction of pharyngocutaneous fistulas after laryngectomy.
OBJECTIVE
To assess the predictive value of wound amylase as an indicator for pharyngocutaneous fistula development following laryngectomy for cancer.


METHODS
We conducted a prospective observational study at a tertiary referral center of 102 consecutive laryngeal or hypopharyngeal cancer patients undergoing laryngectomy with or without pharyngectomy.


METHODS
Data were collated on potential predictors of fistula formation compared with rate of development of clinical fistulas, all confirmed radiologically.


METHODS
Rate of fistula formation was determined for the following potential predictors: extent of resection (extended laryngectomy), postoperative wound (drain) amylase, previous radiotherapy, neck dissection, preoperative and postoperative hemoglobin and albumin levels, and postoperative transfusion. Sensitivity, specificity, and positive and negative predictive values of significant predictors were ascertained.


RESULTS
The only significant predictors of fistula formation were extent of resection (extended laryngectomy) and drain amylase >4000 IU/L. If both factors are combined, the sensitivity, specificity, and positive and negative predictive values for fistula development are 83, 94, 63, and 98 percent, respectively.


CONCLUSIONS
We advocate that patients be managed postoperatively according to the presence or absence of these given predictors to reduce occurrence of fistula formation in the high-risk group.
Morton
Randall P
RP
Department of Otolaryngology-Head and Neck Surgery, Auckland Hospital, Auckland, New Zealand. RPMorton@middlemore.co.nz
Mehanna
Hisham
H
Hall
Francis T
FT
McIvor
Nicholas P
NP
D000681:Amylases / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D017577:Cutaneous Fistula / Q000000981:diagnostic imaging / Q000201:enzymology / Q000209:etiology* / Q000601:surgery; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006785:Hospitals, University; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010608:Pharyngeal Diseases / Q000209:etiology; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D010611:Pharyngectomy / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
D015415:Biomarkers; D006454:Hemoglobins; D012709:Serum Albumin; D000681:Amylases