title: Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches.
abstract: OBJECTIVE
  To investigate the incidence and predisposing factors in the development of postoperative pharyngocutaneous fistula (PCF) after total laryngectomy.
  
  
  METHODS
  A total of 166 patients with complete medical records who underwent total laryngectomy (TL) due to laryngeal cancer were analysed retrospectively. The mean age of the patients was 57.4 (+ 19.6) years. This study looked at a total of 32 different parameters considered to be effective in the development of pharyngocutaneous fistula after total laryngectomy.
  
  
  RESULTS
  Thirty-two patients (19.2%) had a pharyngocutaneous fistula. Aged over 61 years (p = 0.003), Diabetes Mellitus (DM) (p = 0.002), alcohol use (p = 0.006), history of preoperative radiotherapy (p = 0.001), preoperative tracheotomy (p = 0.017), postoperative low levels of haemoglobin (Hb) (p = 0.029), low levels of preoperative albumin (p = 0.001), total protein and a low alb/glb (albumin/globulin) ratio (p = 0.001), serum prealbumin levels on the third and seventh postoperative days (p = 0.001), high postoperative CRP levels (p = 0.002), T4 stage (extralaryngeal) and presence of transglottic lesion (p = 0.003), presence of stage IV (p = 0.012) lesion, primary surgery accompanied by bilateral neck dissection (p = 0.047), T-shaped oesophagus suture, postoperative bleeding (p = 0.07), presence of postoperative fever (p = 0.001), presence of skin defect in the anterior neck (p = 0.001) and presence of postoperative depression (p = 0.001) were found to be statistically significant factors in the development of PCF.
  
  
  CONCLUSIONS
  Our study found many parameters associated with an increased risk of the development of PCF. According to the multivariate regression analysis, aged over 61 years, DM, preoperative RT, preoperative tracheostomy, postoperative Hb under 10 g/dl, prealbumin under 17 mg/dl on the third postoperative day, and a postoperative fever of 38.3 degrees C and above were found be associated with a higher risk of the development of fistulae more than the other risk factors.
authors.forename: C
authors.initials: C
authors.lastname: Kiliç
authors.forename: U
authors.initials: U
authors.lastname: Tuncel
authors.forename: E
authors.initials: E
authors.lastname: Cömert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein; D015331:Cohort Studies; D017577:Cutaneous Fistula / Q000453:epidemiology* / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005402:Fistula / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000592:standards; D009367:Neoplasm Staging; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011878:Radiotherapy / Q000592:standards; D019651:Plastic Surgery Procedures; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D014139:Tracheostomy / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents; D012709:Serum Albumin; D002097:C-Reactive Protein