Predictive factors for the postlaryngectomy pharyngocutaneous fistula development: systematic review.
OBJECTIVE
Pharyngocutaneous fistula is considered one of the major complications in the postoperative period after total laryngectomy/pharyngolaryngectomy, leading to a severe adverse impact for the patient and society. This study aimed to identify all the described pharyngocutaneous fistula predictive factors and risk classifications.


METHODS
Research was conducted to identify all the studies assessing predictive factors and risk classification for pharyngocutaneous fistula development published until April of 2012 (n = 846). The included studies were analyzed and data regarding their identification, methodological quality and results were recorded.


RESULTS
A total of 39 studies were included. The variables consistently reported as associated with fistula development were nutritional deficiency, American Society of Anesthesiologists (ASA) classification, high consumption of alcohol, anemia and hypoalbuminemia, co-morbidities, advanced N stage, location and extent of primary tumor, pre-radiotherapy and pre-chemoradiotherapy treatment, emergency tracheotomy, surgical margin status, surgery's duration, surgeon's experience, local complications of the wound, performance of intraoperative blood transfusion and relationship between nasogastric tube and oral feeding.


CONCLUSIONS
Several risk factors were associated with pharyngocutaneous fistula formation in the included studies. However, there is still no consensus in the most pertinent selection. Only two classification systems were retrieved and they were not able to accurately predict pharyngocutaneous fistula.
Departamento de Ciências da Informação e Decisão de Saúde, Faculdade de Medicina do Porto, Porto, Portugal.
Suzana Boltes
SB
Cecatto
Departamento de Ciências da Informação e Decisão de Saúde, Faculdade de Medicina do Porto, Porto, Portugal.
Matilde Monteiro
MM
Soares
Departamento de Ciências da Informação e Decisão de Saúde, Faculdade de Medicina do Porto, Porto, Portugal.
Teresa
T
Henriques
Departamento de Otorrinolaringologia, Instituto Português de Oncologia do Porto, Porto, Portugal.
Eurico
E
Monteiro
Departamento de Otorrinolaringologia, Hospital São João, Faculdade de Medicina do Porto, Universidade do Porto, Portugal.
Carla Isabel Ferreira Pinto
CI
Moura
D017577:Cutaneous Fistula / Q000209:etiology*; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects*; D010608:Pharyngeal Diseases / Q000209:etiology*; D012307:Risk Factors