Correlation of pharyngeal fistulization with preoperative radiotherapy, reduced serum albumen, and dietary obstruction.

The clinical courses of patients on the Head and Neck Service undergoing radical procedures were reviewed in retrospect. Factors that appeared to influence the courses such as preoperative radiotherapy, reduced serum albumen, and preoperative oropharyngeal obstruction were correlated with fistulization rate, flap necrosis, and other complications. The study included 105 radical procedures performed over a seven-month period. Sixty-six of these operations included laryngectomies, laryngopharyngectomies, and composite resections. The overall complication rate was 37%, with major complications accounting for 9%. A fistula rate of 20% was found in the pharyngeal group and ranged from 12% in the nonirradiated patients to 44% in the irradiated group. Thos patients with preoperative obstruction secondary to tumor bulk had a complication rate of 58%. Patients with reduced serum albumen levels had a higher complication rate of 55% compared with 35% for the group with normal albumen levels. This study suggests that preoperative replenishment of protein, particularly in the obstructed patient or in those with reduced serum albumen levels, would correlate with a more favorable clinical course.