Pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis of risk factors.
OBJECTIVE
The pharyngocutaneous fistula (PCF) is the troublesome complication after total laryngectomy. Despite a large number of investigations having been performed, there is still controversy about which factors are most significant for PCF. The objective of the present meta-analysis was to analyze the potential risk factors for PCF after total laryngectomy.


METHODS
Published English-language literature.


METHODS
PubMed, Ovid, Cochrane, and Web of Science databases were systematically searched using multiple search terms. Twenty-one studies with 3832 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence.


RESULTS
Sixteen studies involving 2598 patients were included for the meta-analysis. The results showed that, tumor subsite (RR=0.64, 95% CI 0.47-0.88, P<0.01), T stage (RR=0.70, 95% CI 0.51-0.96, P=0.03), previous radiotherapy (RR=0.62, 95% CI 0.46-0.84, P<0.01), postoperative hemoglobin <12.5g/L (RR=0.46, 95% CI 0.27-0.76, P<0.01), and surgical margin (RR=0.41, 95% CI 0.22-0.74, P<0.01) were the risk factors associated with the development of PCF.


CONCLUSIONS
From the results of our study, several significant risk factors for PCF are identified. Methodologically high-quality comparative studies are needed for further evaluation.
Department of Head and Neck Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang 110042, People's Republic of China.
Ji-Wang
JW
Liang
Department of Head and Neck Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang 110042, People's Republic of China. Electronic address: lizhendong1964@163.com.
Zhen-Dong
ZD
Li
Department of Head and Neck Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang 110042, People's Republic of China.
Shu-Chun
SC
Li
Department of Head and Neck Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang 110042, People's Republic of China.
Feng-Qin
FQ
Fang
Department of Head and Neck Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang 110042, People's Republic of China.
Yue-Jiao
YJ
Zhao
Department of Head and Neck Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, Dadong District, Shenyang 110042, People's Republic of China.
Yan-Guo
YG
Li
D017577:Cutaneous Fistula / Q000453:epidemiology*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy; D007830:Larynx / Q000473:pathology; D010608:Pharyngeal Diseases / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors
D006454:Hemoglobins
Meta-analysis; Pharyngocutaneous fistula; Risk factor; Total laryngectomy