title: Pharyngocutaneous fistula after salvage laryngectomy: impact of interval between radiotherapy and surgery, and performance of bilateral neck dissection.
abstract: BACKGROUND
  Pharyngocutaneous fistula is a serious complication of total laryngectomy. The purpose of this study was to examine predisposing factors at our institution.
  
  
  METHODS
  We conducted a retrospective review of 94 consecutive patients undergoing total laryngectomy. Cases with hypopharyngeal primary tumors or undergoing extended hypopharyngeal resection with flap augmentation of the pharynx were excluded.
  
  
  RESULTS
  Seventy-four cases met inclusion criteria. A total of 25.7% patients developed a pharyngocutaneous fistula. The fistula rate was higher after salvage laryngectomy than after primary surgery (34.0% vs 11.1%; p = .05). Among salvage laryngectomies, performance of laryngectomy within 1 year of completion of radiotherapy (p = .006) and performance of concomitant bilateral neck dissection (p = .02) were significant risk factors for development of a fistula. Radiation dose, addition of chemotherapy, use of pectoralis major myofascial flap, preoperative tracheostomy, primary puncture, primary tumor subsite, and initial T classification were not significant.
  
  
  CONCLUSIONS
  Interval between completion of radiotherapy and surgery is significantly associated with pharyngocutaneous fistula after salvage total laryngectomy.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland.
authors.forename: Naveed
authors.initials: N
authors.lastname: Basheeth
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Leary
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000209:etiology*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010608:Pharyngeal Diseases / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects*; D013997:Time Factors
keywords: complications; laryngectomy; larynx cancer; pharyngocutaneous fistula; radiotherapy