Maria Casasayas1, Aina Sansa2, Jacinto García-Lorenzo2, Montserrat López2, César Orús2, Xavier Peláez3, Miquel Quer2, Xavier León2,4. 1. Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, C/ Mas Casanovas, 90, 08041, Barcelona, Spain. mcasasayas@santpau.cat. 2. Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, C/ Mas Casanovas, 90, 08041, Barcelona, Spain. 3. Anesthesiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 4. Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
Abstract
PURPOSE: The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system. METHODS: This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality. RESULTS: PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels < 99 g/L were associated with a significantly higher risk of developing major fistula. CONCLUSIONS: We propose a new PCF classification system according to clinical severity. Predictors of major fistula were the type of surgery, previous radiotherapy, and low (< 99 g/L) postoperative hemoglobin levels. We consider the use of onlay flaps in irradiated patients who require partial pharyngectomy.
PURPOSE: The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system. METHODS: This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality. RESULTS: PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels < 99 g/L were associated with a significantly higher risk of developing major fistula. CONCLUSIONS: We propose a new PCF classification system according to clinical severity. Predictors of major fistula were the type of surgery, previous radiotherapy, and low (< 99 g/L) postoperative hemoglobin levels. We consider the use of onlay flaps in irradiated patients who require partial pharyngectomy.
Entities:
Keywords:
Cancer larynx; Pharyngectomy; Pharyngocutaneous fistula; Postoperative complications; Total laryngectomy
Authors: Daniel Jacobs; Samipya Kafle; Joseph Earles; Rahmatullah Rahmati; Saral Mehra; Benjamin L Judson Journal: Laryngoscope Investig Otolaryngol Date: 2021-01-14
Authors: Teresa Bernadette Steinbichler; Dolores Wolfram; Annette Runge; Roland Hartl; Daniel Dejaco; Tina Rauchenwald; Claus Pototschnig; Herbert Riechelmann; Volker Hans Schartinger Journal: Head Neck Date: 2021-04-08 Impact factor: 3.821