Pharyngocutaneous fistula following total laryngectomy

Abstract

Pharyngocutaneous fistula is the most common complication after total laryngectomy. The aim of the study was to establish the incidence of this complication in our series and analyse the predisposing factors. This is a retrospective study comprising 55 patients who underwent total laryngectomy. The following aspects were considered: sex, age, tumour site, pathologic staging according to TNM, performance and type of neck dissection, previous radiation therapy, previous tracheotomy, Cumulative Illness Rating Scale for comorbidity analysis, the use of stapler for pharyngeal closure, and peri-operative blood transfusion. In the cases of pharyngocutaneous fistula, we considered the post-operative period in which it was diagnosed, duration, period of hospitalization, as well as therapeutic approach and the eventual result of this treatment. Pharyngocutaneous fistula was diagnosed in 7 patients (12.7%). There were no statistically significant associations between fistula development and sex (p = 1.000), previous radiation therapy (p = 0.354), stapler closure (p = 0.577), comorbidity (p = 1.000) or tumour site (p = 0.926). Patients previously submitted to tracheotomy presented higher fistula incidence (60%), compared to those that had not undergone this procedure (8%) (p = 0.012). Elderly patients (>60 years) were also more predisposed to fistula development (p = 0.051). Although without statistical significance, fistula development was also associated with peri-operative blood transfusion, T stage, and type of neck dissection.