title: Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors.
abstract: BACKGROUND
  Pharyngocutaneous fistula (PCF) is the most common surgical complication after total laryngectomy. Controversy still remains regarding the multiple risk factors implicated. The purpose of this study was to evaluate the potential risk factors for PCF.
  
  
  METHODS
  The strategy for our literature survey included research in MEDLINE up to December 2013. The risk factors analyzed were age, sex, smoking habit, alcohol use, comorbidity, preoperative hemoglobin level, blood transfusion, preoperative tracheotomy, previous radiotherapy and chemoradiotherapy, primary tumor site, T classification, cartilage invasion, tumor grade, surgical margins, suture material, second layer of suture, reconstruction, tracheoesophageal prosthesis, and neck dissection.
  
  
  RESULTS
  The electronic search resulted in 311 studies from which 63 met the inclusion criteria.
  
  
  CONCLUSIONS
  Chronic obstructive pulmonary disease (COPD), previous hemoglobin <12.5g/dL, blood transfusion, previous radiotherapy or chemoradiotherapy, advanced primary tumors, supraglottic subsite, hypopharyngeal tumor site, positive surgical margins, and the performance of neck dissection were risk factors for PCF.
authors: Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Rogério Aparecido
authors: RA
authors: Dedivitis
authors: Department of General Surgery, Hospital Ana Costa, Santos, Brazil.
authors: Felipe Toyama
authors: FT
authors: Aires
authors: Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Claudio Roberto
authors: CR
authors: Cernea
authors: Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Lenine Garcia
authors: LG
authors: Brandão
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D017577:Cutaneous Fistula / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D010608:Pharyngeal Diseases / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors
keywords: carcinoma; cutaneous fistula; laryngeal neoplasms; laryngectomy; meta-analysis; postoperative complications; squamous cell carcinoma