[Pharyngocutaneous fistula after total laryngectomy: incidence, predisposing factors, and treatment]

Abstract

Objectives: We investigated the incidence and etiologic factors of pharyngocutaneous fistulas occurring after total laryngectomy.

Patients and methods: The study included 53 patients (46 males, 7 females; mean age 59 years; range 34 to 84 years) who underwent total laryngectomy for epidermoid carcinoma. Risk factors for pharyngocutaneous fistula, its incidence and time of occurrence, treatment approaches, and length of hospital stay were evaluated.

Results: Pharyngocutaneous fistula developed in 19 patients (35.9%) within a mean of 7.4 days postoperatively. Age, smoking, the presence of chronic systemic disease; T1-T2 stage, localization, and differentiation of tumor, concomitant bilateral neck dissection, T/Y shaped pharyngeal closure, and high fever in the first postoperative 48 hours did not show any significant relationship with the formation of fistula. Factors significantly associated with fistula formation were T4 stage, alcohol consumption, postoperative anemia, and hypoproteinemia. The mean hospital stay was 40.5 days in patients with pharyngocutaneous fistula compared with 15.3 days in patients without fistula.

Conclusion: Postoperative anemia, hypoproteinemia, alcohol consumption, and T4 stage are significant risk factors for pharyngocutaneous fistula formation.