title: Comparison of pharyngocutaneous fistula between patients followed by primary laryngopharyngectomy and salvage laryngopharyngectomy for advanced hypopharyngeal cancer.
abstract: 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.
authors.affiliation: Department of Otolaryngology, China Medical University Hospital, Taichung City, Taiwan, Republic of China.
authors.forename: Yung-An
authors.initials: YA
authors.lastname: Tsou
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Hua
authors.forename: Meng-Hung
authors.initials: MH
authors.lastname: Lin
authors.forename: Hsien-Chang
authors.initials: HC
authors.lastname: Tseng
authors.forename: Ming-Hsui
authors.initials: MH
authors.lastname: Tsai
authors.forename: Ashok
authors.initials: A
authors.lastname: Shaha
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D012709:Serum Albumin; D002945:Cisplatin