Salvage laryngectomy after primary radiotherapy: what are prognostic factors for the development of pharyngocutaneous fistulae?

In this evidence based case report we addressed the clinical question: which factors predict the occurrence of a pharyngocutaneous fistula after total laryngectomy in patients that already were treated with radiotherapy for a squamous cell carcinoma of the larynx? We searched for relevant synonyms for the domain, being patients earlier treated with radiotherapy for a squamous cell carcinoma of the larynx and having a recurrence for which a salvage total laryngectomy is necessary, with the outcome being the development of a post-operative pharyngocutaneous fistula. We searched for relevant publications in Embase, Pubmed and Web of Science using search terms in title and abstract fields. The search yielded 1764 records, of which three were relevant and valid for our clinical question. Our results show that the absolute risk of a pharyngocutaneous fistula after total laryngectomy in patients earlier treated with radiotherapy for a squamous cell carcinoma of the larynx mainly depends on characteristics and site of the primary tumor. In patients who have a primary glottic laryngeal T1 or T2 tumor the absolute risk of developing a fistula is 11% (95% CI 6; 15%), whereas the risk of developing a fistula in patients with a T3 or T4 extra laryngeal tumor is 35% (95% CI 25; 46%). Other patient and surgical characteristics can however not be ruled out as important prognostic factors since many of them have to date not been studied, e.g. diabetes mellitus, alcohol consumption, smoking, suture materials and surgical technique used.