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Sunday, March 13, 2016

Risk factors for pharyngocutaneous fistula after laryngectomy

Pharyngocutaneous fistula (PCF) is the most common surgical complication after total laryngectomy. Controversy still remains regarding the multiple risk factors implicated.

Dedivitiset al. surveyed the literature up to December 2013. The risk factors analyzed were age, sex, smoking habit, alcohol use, comorbidity, preoperative hemoglobin level, blood transfusion, preoperative tracheotomy, previous radiotherapy and chemoradiotherapy, primary tumor site, T classification, cartilage invasion, tumor grade, surgical margins, suture material, second layer of suture, reconstruction, tracheoesophageal prosthesis, and neck dissection. Of the 311 studies that were evaluated 63 met the inclusion criteria.

The author found that the risk factors for PCF were: chronic obstructive pulmonary disease (COPD), previous hemoglobin < 12.5 g/dL, blood transfusion, previous radio or chemotherapy, advanced primary tumor, suprglotic subsite, hypopharyngeal tumor site, positive surgical margins, and the performance of neck dissection.

Liang et al. who performed meta-analysis on on 16 studies found that tumor ssubsite, T stage, previous radiotherapy, postoperative hemoglobin < 12.5 g/dL, and surgical margins were the risk factors associated with the development of PCF.

Recognition of these factors can assist clinicians in expecting and treating PCF.

MRI of a pharyngocutaneous fistula after laryngopharyngectomy, and radial forearm free flap