Assessment and incidence of salivary leak following laryngectomy.
OBJECTIVE
To determine the incidence and risk factors of pharyngocutaneous fistula formation in patients undergoing either primary or salvage laryngectomies and evaluate the role of barium esophagram in these patients.


METHODS
Retrospective cohort study.


METHODS
Medical records of 259 patients who underwent total laryngectomy between 2003 and 2009 at our institution were reviewed. Risk factors for fistula formation were analyzed, including primary treatment modality, comorbidities, and operative details, which included use of a free flap for closure, concurrent neck dissections, margin status, and preoperative tracheostomy. The length of time until leak, postoperative swallow study results, and fistula management strategies were also assessed.


RESULTS
Fifty-five patients developed a pharyngocutaneous fistula (overall incidence, 21%) in a median time of 12 days (range, 4-105 days). Twenty of these patients underwent laryngectomy as their initial treatment modality, and 35 had failed previous radiotherapy. Fistula formation was significantly higher in salvage surgery patients (P = .03), particularly those with hypothyroidism (P < .0002). A barium swallow performed at approximately 1 week after laryngectomy demonstrated a sensitivity of 26% with a specificity of 94%. Sixty-two percent of the fistulas healed with conservative measures only.


CONCLUSIONS
Our data confirmed that previous radiotherapy and hypothyroidism, particularly in salvage laryngectomy patients, are important significant predictors of postoperative pharyngocutaneous fistula. The use of a postoperative barium swallow in these patients may be useful but was not found to be highly sensitive in predicting who will develop a clinically evident leak and should be used with caution.
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Hilliary N
HN
White
Blake
B
Golden
Larissa
L
Sweeny
William R
WR
Carroll
Jeffery S
JS
Magnuson
Eben L
EL
Rosenthal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D003430:Cross-Sectional Studies; D017577:Cutaneous Fistula / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005402:Fistula / Q000453:epidemiology* / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors; D016879:Salvage Therapy; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery