Predictive Value of Risk Factors for Pharyngocutaneous Fistula After Total Laryngectomy.

Abstract

To assess the predictive value of various risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy. The characteristics of each study were collected from six databases up to January of 2022. Risk for bias was assessed using the QUADAS-2 tool. A total of 58 studies in 9845 patients were included in the analysis. The incidence of PCF was 21.69%, 95% confidence intervals (CI) [0.20; 0.24] in the included studies. Age (OR=1.33, 95% CI [1.12; 1.58]), postoperative anemia (OR=2.29, 95% CI [1.47; 3.57]), diabetes mellitus (OR=1.81, 95% CI [1.20; 2.71]), tumor site (above or below the glottis) (OR=1.47, 95% CI [1.15; 1.88]), previous radiation therapy (OR=2.06, 95% CI [1.56; 2.72]), previous tracheostomy (OR=1.26, 95% CI [1.04; 1.53]), surgery timing (salvage vs. primary) (OR=2.08, 95% CI [1.46; 2.97]), extended total laryngectomy (including pharyngectomy) (OR=1.96, 95% CI [1.28; 3.00]), primary tracheoesophageal puncture (OR=0.61, 95% CI [0.40; 0.93]), and postoperative hypoproteinemia (OR=9.98, 95% CI [3.68; 27.03]) were significantly associated with the occurrence of PCF. In view of predictive ability, postoperative hypoproteinemia showed the highest accuracy (sensitivity=51%, specificity=90%, area under the curve=0.84). Multiple patient-, disease-, and surgery-related factors are risk factors for PCF. In particular, postoperative hypoproteinemia could be a good predictive factor for PCF in patients undergoing total laryngectomy. Laryngoscope, 133:742-754, 2023.