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. 2021 Mar 10;13(3):e13797.
doi: 10.7759/cureus.13797.

Influence of Preoperative Radiation Therapy on the Occurrence of Pharyngocutaneous Fistula After Total Laryngectomy

Masaaki Higashino  1 , Teruhito Aihara  1 , Tetsuya Terada  1 , Ryo Kawata  1
Affiliations

Influence of Preoperative Radiation Therapy on the Occurrence of Pharyngocutaneous Fistula After Total Laryngectomy

Masaaki Higashino et al. Cureus. .

Abstract

Introduction Chemo-radiotherapy (CRT) has increasingly been employed for the treatment of laryngeal cancer at T3 or higher rather than total laryngectomy (TL), in order to preserve the larynx. However, TL is still frequently performed in patients with advanced laryngeal cancer, especially T4 disease. When CRT is performed for advanced cancer, there is a certain rate of residual disease or relapse, and TL is conducted as salvage surgery for those patients, but TL following CRT is associated with a high incidence of postoperative complications. Objective The purpose of this study was to investigate the influence of preoperative radiation therapy on the occurrence of postoperative complications of TL, particularly pharyngocutaneous fistula (PCF). Methods We retrospectively investigated 142 patients who underwent TL for laryngeal cancer whether postoperative complications were related to a history of radiation therapy or neck dissection. Detailed investigation of the 32 patients who underwent radiation therapy was also conducted. Results PCF was significantly higher after radiation therapy. Neck dissection was not related. As the time from radiation therapy to TL decreased, the incidence rate of postoperative PCF increased and the time to closure became significantly longer. Preoperative laboratory tests did not show a significant difference in Hb and Alb, but the lymphocyte count was significantly lower in patients with PCF.

Keywords: laryngeal carcinoma; neck dissection; pharyngocutaneous fistula; preoperative lymphocyte; radiation therapy; total laryngectomy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Postoperative complications after TL and the history of radiation therapy
The incidence of postoperative complications was significantly higher in patients who received radiation therapy than patients without radiation therapy (p<0.001). TL: total laryngectomy
Figure 2
Figure 2. Postoperative complications after TL and the neck dissection
There was no significant difference in the frequency of complications whether conducted neck dissection was conducted or not (p=0.65). TL: total laryngectomy
Figure 3
Figure 3. The interval from completion of radiation to salvage surgery (TL)
The median interval from completion of radiation to salvage surgery (TL) was six months (3-276 months) in Group A and 20 months (3-153 months) in Group B, and it was significantly shorter in Group A than in Group B (p=0.015). TL: total laryngectomy
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