title: Postlaryngectomy pharyngocutaneous fistula: determining the risk of preoperative tracheostomy and primary tracheoesophageal puncture.
abstract: BACKGROUND
  This article considers whether preoperative tracheostomy and primary tracheoesophageal puncture (TEP) contribute as independent risk factors to the development of pharyngocutaneous fistula (PCF), as well as discusses the significant factors related to the perioperative management of these patients.
  
  
  METHODS
  Retrospective data were collected on 145 patients treated with total laryngectomy/pharyngolaryngectomy between January 2003 and July 2010 at the Victoria Hospital in London, Ontario, including whether preoperative tracheostomy or primary TEP was performed.
  
  
  RESULTS
  One in four (25%) patients developed a postoperative PCF. No increase in PCF rates was observed with either preoperative tracheostomy or primary TEP. Salvage surgery PCFs achieved lower rates of spontaneous closure compared to those undergoing primary surgery (p  =  .002).
  
  
  CONCLUSIONS
  Neither preoperative tracheostomy nor primary TEP was associated with the development of PCF. Surgical closure of PCF is more likely to be required in the setting of salvage surgery.
authors: Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
authors: Samuel A
authors: SA
authors: Dowthwaite
authors: Janie
authors: J
authors: Penhearow
authors: Christopher
authors: C
authors: Szeto
authors: Anthony
authors: A
authors: Nichols
authors: Jason
authors: J
authors: Franklin
authors: Kevin
authors: K
authors: Fung
authors: John
authors: J
authors: Yoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017577:Cutaneous Fistula / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D011677:Punctures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000009:adverse effects*