Comparison of pharyngocutaneous fistula between patients followed by primary laryngopharyngectomy and salvage laryngopharyngectomy for advanced hypopharyngeal cancer.
BACKGROUND
We analyzed the incidence rate, possible etiology, and management of pharyngocutaneous fistula after laryngopharyngectomy between hypopharyngeal cancer patients who received surgery first and subsequently concurrent chemoradiation therapy (CCRT) and those who received CCRT first followed by surgical salvage.


METHODS
This is a case cohort, retrospective study collected in a tertiary medical center from January 1996 to July 2007.


RESULTS
From the total of 160 patients, 52 patients (32.5%) developed pharyngocutaneous fistula. There is a significant difference between the pharyngocutaneous fistula rate of those with initial CCRT and the initial surgery groups. By univariate analysis and multiple logistic regression, tests revealed that preoperative radiation and hypo-albuminemia are risk factors for pharyngocutaneous fistula. A prolonged hospital course was noted among patients in the fistula group, especially when they received surgical repair, had hypo-albuminemia (albumin, <2.5 g/dL), or received preoperative radiation therapy (pre-OPRT).


CONCLUSIONS
Preoperative radiation therapy and hypo-albuminemia increase the fistula rate significantly. A prolonged hospital course was noted among all fistula patients.
Tsou
Yung-An
YA
Department of Otolaryngology, China Medical University Hospital, Taichung City, Taiwan, Republic of China.
Hua
Chun-Hung
CH
Lin
Meng-Hung
MH
Tseng
Hsien-Chang
HC
Tsai
Ming-Hsui
MH
Shaha
Ashok
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D015331:Cohort Studies; D017577:Cutaneous Fistula / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection; D020360:Neoadjuvant Therapy; D010608:Pharyngeal Diseases / Q000209:etiology* / Q000601:surgery; D010611:Pharyngectomy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors
D000970:Antineoplastic Agents; D012709:Serum Albumin; D002945:Cisplatin