Prediction of pharyngocutaneous fistula and survival after salvage laryngectomy for laryngohypopharyngeal carcinoma

Abstract

Background: This study examined the risk factors of pharyngocutaneous fistula development and poor survival after salvage laryngectomy.

Methods: Binary logistic regression analyses were carried out to analyze the relationship between post-salvage fistula development and variables. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate prognostic factors associated with disease-free survival (DFS) and overall survival (OS) after salvage laryngectomy.

Results: Multivariate analyses showed that previous radiotherapy and pre-salvage tracheostomy were the independent variables predictive of post-salvage fistula development (all P < .05). The 5-year DFS and OS rates were 58.8% and 45.9%, respectively. Multivariate analyses showed that nodal positivity at salvage remained the independent factor predictive of both DFS (hazard ratio [HR] 2.83, P = .002) and OS (HR 2.22, P = .006).

Conclusions: Fistula development after salvage laryngectomy might be predicted by a history of radiotherapy or tracheostomy. Post-salvage survival is associated with nodal positivity at salvage.

Condensed abstract: This study examined the risk factors of pharyngocutaneous fistula development and survival in 103 patients who underwent salvage laryngectomy. Previous radiotherapy and tracheostomy were the independent variables predictive of post-salvage fistula development, and nodal positivity at salvage was the independent factor predictive of both disease-free survival and overall survival.

Keywords: laryngohypopharyngeal cancer; pharyngocutaneous fistula; risk factors; salvage surgery; survival.