Pharyngocutaneous Fistula Following Total Laryngectomy. ACase-Control Study of Risk Factors Implicated in its Onset

Abstract

Pharyngocutaneous fistula is the most frequent complication after total laryngectomy. Risk factors involved in its appearance have been studied by many authors without conclusive results. Our main objective is to identify the risk factors involved in the onset of fistulae at our institution. A retrospective case-control study was designed. Thirty-three patients subjected to total laryngectomy with the same protocol were included in both groups. Patients who required a complex surgical reconstruction were excluded in order to avoid biases. The only risk factor with statistical significance (P=.04) for the onset of fistulae in our setting is the extension of the surgery to the pharynx (OR=2.83). The association of prior radiotherapy and concurrent neck dissection displayed a notable trend (OR=0.32) but without significance (P=.099). Patient age, prior radiotherapy, concurrent neck dissection, prior tracheotomy and post-operative haemoglobin level did not predispose to this complication in our study. Non-surgical closure of the pharyngocutaneous fistula was achieved in most cases (72.7 %) but patients who had pre-operative radiotherapy required surgical closure more frequently (P< .01) than those not irradiated. At our centre the main risk factor associated with post-laryngectomy fistulae is the extension of surgery to the pharynx. In previously-irradiated patients, fistulae have a lower incidence of non-surgical closure and require more aggressive surgery to resolve them.