title: Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities.
abstract: The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A retrospective, match-paired analysis of 86 patients who developed fistula after total laryngectomy was carried out and compared with a control group of 86 patients without fistula, randomly selected from a pool of 352 total laryngectomies, performed between January 1999 to October 2014. The overall incidence of PCF in the series was 24.4%; we recorded rates of 19.0%, 28.6% and 30.3% following primary total laryngectomy (PTL), salvage laryngectomy post-radiotherapy (RT-STL) and salvage laryngectomy postchemoradiotherapy (CRT-STL), respectively. Multivariate analysis revealed that the relative risk of fistula was respectively 2.47, 3.09 and 7.69 for hypoalbuminaemia ≤3.5 g/dL, RT-STL and CRT-STL. An early onset of PCF within 10 postoperative days was recorded in case of salvage total laryngectomy. The management of PCF significantly differed between PTL, RT-STL and CTRT-STL, with exclusive conservative treatment for PTL (93.55%), while in the CRT-STL group surgical closure with regional flaps (58.82%) prevailed. Conservative management, adjuvant hyperbaric oxygen therapy and surgical closure were equally distributed in the RT-STL group. Thorough knowledge of patient-related risk factors and its prognostic value, allows the surgeon to better evaluate preventive strategies with the aim of minimising fistula formation, hospitalisation times and related costs.
authors.affiliation: First Clinic of Otolaryngology Head-Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Busoni
authors.affiliation: First Clinic of Otolaryngology Head-Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Deganello
authors.affiliation: First Clinic of Otolaryngology Head-Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Florence, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Gallo
mesh_terms: D017577:Cutaneous Fistula / Q000209:etiology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects*; D010608:Pharyngeal Diseases / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Chemoradiotherapy; Pharyngocutaneous fistula; Risk factors; Salvage total laryngectomy