BACKGROUND: Pharyngocutaneous fistula is a serious complication of total laryngectomy. The purpose of this study was to examine predisposing factors at our institution. METHODS: We conducted a retrospective review of 94 consecutive patients undergoing total laryngectomy. Cases with hypopharyngeal primary tumors or undergoing extended hypopharyngeal resection with flap augmentation of the pharynx were excluded. RESULTS: Seventy-four cases met inclusion criteria. A total of 25.7% patients developed a pharyngocutaneous fistula. The fistula rate was higher after salvage laryngectomy than after primary surgery (34.0% vs 11.1%; p = .05). Among salvage laryngectomies, performance of laryngectomy within 1 year of completion of radiotherapy (p = .006) and performance of concomitant bilateral neck dissection (p = .02) were significant risk factors for development of a fistula. Radiation dose, addition of chemotherapy, use of pectoralis major myofascial flap, preoperative tracheostomy, primary puncture, primary tumor subsite, and initial T classification were not significant. CONCLUSION: Interval between completion of radiotherapy and surgery is significantly associated with pharyngocutaneous fistula after salvage total laryngectomy.
BACKGROUND: Pharyngocutaneous fistula is a serious complication of total laryngectomy. The purpose of this study was to examine predisposing factors at our institution. METHODS: We conducted a retrospective review of 94 consecutive patients undergoing total laryngectomy. Cases with hypopharyngeal primary tumors or undergoing extended hypopharyngeal resection with flap augmentation of the pharynx were excluded. RESULTS: Seventy-four cases met inclusion criteria. A total of 25.7% patients developed a pharyngocutaneous fistula. The fistula rate was higher after salvage laryngectomy than after primary surgery (34.0% vs 11.1%; p = .05). Among salvage laryngectomies, performance of laryngectomy within 1 year of completion of radiotherapy (p = .006) and performance of concomitant bilateral neck dissection (p = .02) were significant risk factors for development of a fistula. Radiation dose, addition of chemotherapy, use of pectoralis major myofascial flap, preoperative tracheostomy, primary puncture, primary tumor subsite, and initial T classification were not significant. CONCLUSION: Interval between completion of radiotherapy and surgery is significantly associated with pharyngocutaneous fistula after salvage total laryngectomy.
Authors: Erin J Partington; Lindsay S Moore; Russel Kahmke; Jason M Warram; William Carroll; Eben L Rosenthal; Benjamin J Greene Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-08-01 Impact factor: 6.223
Authors: Carol M Lewis; Thomas A Aloia; Weiming Shi; Ira Martin; Stephen Y Lai; Jesse C Selber; Amy C Hessel; Matthew M Hanasono; Katherine A Hutcheson; Geoffrey L Robb; Randal S Weber Journal: JAMA Otolaryngol Head Neck Surg Date: 2016-04 Impact factor: 6.223
Authors: Eleni M Benson; Richard M Hirata; Carol B Thompson; Patrick K Ha; Carole Fakhry; John R Saunders; Joseph A Califano; Demetri Arnaoutakis; Marshall Levine; Mei Tang; Geoffrey Neuner; Barbara P Messing; Ray G F Blanco Journal: Am J Otolaryngol Date: 2014-09-02 Impact factor: 1.808