Development Of Pharyngocutaneous Fistula Research Articles

Platelet-rich fibrin: an autologous biomaterial for healing assistance of pharyngeal repair in total laryngectomy.

The aim of this study was to evaluate the potential role of platelet-rich fibrin (PRF) application on the pharyngeal repair on decreasing the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy. This randomized controlled clinical trial was conducted on 67 patients with advanced laryngeal carcinoma who underwent total laryngectomy, over 2years in the Otorhinolaryngology Department, Mansoura University Hospitals, Egypt. Patients were randomly assigned into two groups: PRF group (n = 35) and control group (n = 32). Risk factors for development of PCF as well as the incidence of PCF were studied in both groups. There was no statistically significant difference between groups regarding demographic data, medical comorbidities, basal hemoglobin and albumin levels, data related to the tumor (location, grade and TNM staging) and surgical details (preoperative tracheotomy and neck dissection). However, regarding the incidence of PCF, there was a statistically significant difference between groups as shown in Table 2. PCF was detected in 2/35 patients (5.7%) in the PRF group and in 10/32 patients (31.3%) in the control group (p = 0.004). PRF application on the pharyngeal repair after total laryngectomy enhances the healing process and consequently decreases the incidence of PCF.

Functional Outcomes and Complications After Salvage Total Laryngectomy for Residual, Recurrent, and Second Primary Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study.

Background/Purpose: We analyzed complications and functional outcomes and aimed at identifying prognostic factors for functional outcomes and complications in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx after initial (chemo)radiation.Methods: Retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018. Prognostic factors for functional outcomes and complications were identified with uni- and multivariable analysis.Results: A total of 405 patients were included in the final analysis. STL was performed for residual tumor (40.2%), local recurrence (40.5%), or second primary laryngeal or hypopharyngeal SCC (19.4%). Early postoperative complications were experienced by 34.2% of patients: postoperative hemorrhage occurred in 5.4%, wound infection in 16.2%, and clinical pharyngocutaneous fistula (PCF) in 25.5% of patients. Early readmission proved necessary in 15.1% of cases, most often due to late PCF development (72.2%). Patients achieved total peroral intake in 94.2% of cases. However, subjective dysphagia was reported by 31.3% of patients during follow-up. Functional speech, defined as functional communication by speech without additional aids, was reported in 86.7% of cases and was most often achieved by tracheo-esophageal puncture (TEP) (94.1%). In a multivariable model, lower preoperative hemoglobin (<12.5 g/dl) was identified as an independent prognostic factor for higher overall complication rate. No risk factors were found significant for clinical fistula formation. Vascularized tissue augmentation did not significantly prevent clinical PCF. Patients with positive section margins, patients initially treated with surgery combined with adjuvant RT (vs. radiotherapy alone), and those developing PCF after STL were less likely to achieve total peroral intake. Postoperative dysphagia proved more likely in patients who developed a PCF postoperatively, and less likely in patients who underwent STL without partial pharyngectomy and in patients with myocutaneous pectoralis major (PM) flap reconstruction, compared to muscle onlay PM flap. Achieving postoperative functional speech proved most likely in patients with smaller tumors (lower pT classification) and free section margins.Conclusion: Substantial complication rates and favorable functional outcomes are reported after STL.

Complications of Total Laryngectomy

Objective: To observe Post-operative complications of Total Laryngectomy in advanced Laryngeal Carcinoma Patients.&#x0D; Methods: This prospective observational study was conducted in National Institute of ENT, Tejgaon, Dhaka. Study duration 3 years, from January 2015 to December 2017. 17 patients were selected who underwent total laryngectomy for histologically proven advanced carcinoma larynx. Patients were followed up monthly for 3 months &amp; then after 6 months for life long.&#x0D; Results: The age of the patients ranged from 39 to 66 years. The mean age was 47 years. Most of the cases are supraglottic carcinoma 12 (70.59%), Glottic carcinoma in 5 (29.41%) &amp; no subglottic carcinoma. In this study, out of 12 supraglottic cases, 4 patients were presented in stage III &amp; 8 in stage IV. Among the glottic cases 1 patient presented in stage I, 2 in stage III &amp; 2 patients presented in stage IV. Patients were followed up monthly for 3 months &amp; then after 6 months for life long. 2 patients (11.76%) developed pharyngocutaneous fistula within 7th to 15th post-operative day &amp; these patients were managed conservatively which involved adequate drainage, frequent dressing &amp; fresh blood transfusion. With these conservative management fistula healed completely within 3 to 4 weeks. 3 patients (17.65%) developed wound infection. Wound swab was sent for culture &amp; sensitivity and antibiotics changed accordingly. Wound healed within 2-3 weeks with conservative treatment &amp; adequate aseptic dressing. 1 patient (5.88%) developed postoperative hematoma which was drained immediately. This patient developed wound infection later on &amp; was managed conservatively. 2 patients (11.76%) developed stomal recurrence 4 months after surgery, which was confirmed by biopsy. The cases were inoperable &amp; were sent for radiotherapy. 2 patients (11.76%) developed dysphagia due to pharyngeal stenosis 4 months after surgery.&#x0D; Conclusion: The most frequent troublesome immediate complication is pharyngocutaneous fistula all of which have been treated conservatively with satisfactory result. Preoperative radiotherapy is an important risk factor for the development of pharyngocutaneous fistula in total laryngectomy.&#x0D; Bangladesh J Otorhinolaryngol; April 2019; 25(1): 10-18

Development of Pharyngocutaneous Fistula after Total Laryngectomy: The Predictive Value of C-reactive Protein/Albumin Ratio.

We aimed to evaluate whether C-reactive protein(CRP)/ Albumin ratio (CAR) performed in the early postoperative period after total laryngectomy could be a predictive factor for the development of pharyngocutaneous fistula (PCF). The files of patients with laryngeal squamous cell carcinoma who underwent total laryngectomy between January 2005 and January 2019 were retrospectively reviewed. Patients were divided into two groups: patients with PCF (PCF group) and without (Non-PCF group). CAR values and risk factors were compared between groups. The overall incidence of PCF was 23.2%. There was a statistically significant difference between the two groups in terms of CRP and CAR levels (p = 0.001). The CAR value of 27.05 (sensitivity = 75.0% , specificity 68.2%, area under curve (AUC) = 0.742, 95% confidence interval 0.616-0.868) was determined as a cutoff value to describe the development of fistula in the early postoperative period. In multiple linear regression analysis, there was an independent relationship between presence of PCF and previous RT and CAR value. CAR, performed in the early postoperative period, may be a new and useful marker for predicting PCF after total laryngectomy.

Bradykinin Receptor B1 and C-Reactive Protein as Prognostic Factors for Pharyngocutaneous Fistula Development After Laryngectomy

Pharyngocutaneous fistulae (PCF) are one of the most common complications after laryngectomy. Predisposing risk factors have been studied, yet knowledge to determine which patients are prone to developing a fistula remains scarce. This study aims to establish prognostic parameters to identify individual patients at risk for PCF development. As PCF and inflammation seem to be interwoven, this work focuses on markers able to detect an inflammatory response. We retrospectively analyzed all patients who had undergone a laryngectomy at our clinic in the years 2007 to 2017 (n = 182). Immunohistochemical expression of bradykinin type 1 and 2 receptor and vascular endothelial growth factor receptor 2 was studied in all available tumor samples. Additionally, the clinical inflammation parameters ‘body temperature’, ‘pain’, ‘c-reactive protein (CRP)’, and ‘leucocytes’ were postoperatively tracked in all patients. The times between fistula diagnosis, therapeutic approach, and hospital discharge were recorded. We found a strong correlation between inflammation and the formation of a fistula. High bradykinin 1 receptor expression in the tumor samples correlated with postoperative PCF development. Persistently elevated CRP and leukocyte levels beyond the 6th postoperative day were also risk factors. A decreased time lapse between PCF diagnosis and surgical revision clearly correlated with a shorter hospital stay. In this study, we identified a bradykinin 1 receptor positive patient group at high risk for development of PCF. We recommend close monitoring for fistula formation in these patients to ensure timely intervention.

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

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

Comparison of Early Versus Delayed Oral Feeding After Total Laryngectomy in Terms of Pharyngocutaneous Fistula Development.

There is still no consensus on the effect of early oral feeding and nasogastric tube feeding on the development of pharyngocutaneous fistula (PCF) after total laryngectomy. The aim of the present study was to compare the effects of early oral feeding and nasogastric tube (NGT) feeding after total laryngectomy on the incidence of PCF. A total of 59 male and three female patients with a mean age of 61.65 (range 44-77) years who underwent total laryngectomy and bilateral neck dissection between May 2010 and June 2016 were evaluated retrospectively. Thirty-two patients started oral feeding on postoperative day three, and 30 patients started NGT feeding on postoperative day one following oral feeding on 7th day. Besides the investigation of the factors which can affect PCF formation, the incidence of PCF was also determined between the two groups of patients. Only preoperative albumin value was different between the groups in the determination of factors which can affect development of PCF. No statistical difference was found between the two groups in terms of the development of PCF and the length of hospital stay (p>0.05). To start oral feeding on postoperative day three or with a NGT feeding on postoperative day one following oral feeding on day seven did not affect the development of PCF and the length of hospital stay in patients who underwent total laryngectomy.

Postoperative Complications аfter Laryngectomy

Theoretical basis: complications after laryngectomy can cause serious consequences for the outcome of treatment. Such complications include: fistula formation, wound infection, lumbo necrosis, post-operative bleeding, dysphagia, and etc. The Aim of the study is to determine the incidence of the most common post-operative complications after laryngectomy. Materials and Methods: A prospective cohort study including 60 patients who had undergone total laryngectomy in the Department of Otorhinolaryngology at the University Hospital “Queen Giovanna” – ISUL, Sofia, 2012-2015. The analysis was conducted on all hospital documentation and postoperative screening of the patients. Results: Development of pharyngocutaneous fistula in the postoperative period was observed in 12 patients. Eleven patients reported post-operative dysphagia. Post-operative bleeding was observed in 2 patients. Loss of weight (BMI <18.5) was documented in 9 of the patients. Discussion: The development of the pharyngocutaneous fistula is the most common complication following laryngectomy. The incidence of postoperative infections in patients undergoing laryngectomy is 23% and may increase in patients undergoing radiotherapy. Balfe et al. in a study of 45 patients reported that 7 of them or 16% developed dysphagia. In another study by Pauloski et al. of 352 patients, 59% of them reported swallowing difficulty. Conclusion: Fistula formation and dysphagia are the most common postoperative complications following laryngectomy.

Sternocleidomastoid flap augmentation of the pharyngeal closure after total laryngectomy.

The objective of the study was to evaluate the effect of sternocleidomastoid (SCM) flap augmentation of the pharyngeal closure after total laryngectomy on the incidence of pharyngocutaneous fistula (PCF). Thirty patients with T4a laryngeal carcinoma and none of them receiving primary radiotherapy previously were divided into two equal groups. Group A patients had SCM flap augmentation of the pharyngeal closure after total laryngectomy. Group B patients had the standard pharyngeal closure without augmentation. Both groups were followed up for 30days postoperatively for the development of PCF. The use of the SCM added about extra 15min to the surgical procedure in all patients (p<0.001). The shape of the suture line of the neopharynx was horizontal in 14 patients (7 in each group) while it was T-shaped in the remaining 16 (8 in each group). Neck dissection was done in all patients except only two patients who previously had the neck dissection done in combination with partial laryngectomy. Three patients in each group developed PCF either early (10days or less postoperatively) or late (more than 10days but less than 30days postoperatively). There was no statistically significant difference in the length of hospital stay between the two groups. The use of SCM flap did not reduce the incidence of PCF after total laryngectomy.

Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model

ObjectiveThe present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model. MethodsThirty female Sprague-Dawley underwent experimental pharyngoesophagotomy and were grouped depending on the material used for pharyngocutaneous fistula closure: group I, which received primary sutures alone, group II, which received bacterial cellulose alone; and group III, which received both. After 7 days, the rats were sacrificed. Pharyngocutaneous fistula development was assessed, the gross wound was inspected, and histological examination was conducted. ResultsPharyngocutaneous fistulae developed in 12 rats (41%) in all: 6 from group I (21%), 4 from group II (14%) and 2 from group III (7%). ConclusionFibroblast density and inflammatory cell infiltration were significantly greater in group III than group I. We concluded that bacterial cellulose may be useful for pharyngocutaneous fistula closure.

Effect of postoperative use of diclofenac on pharyngocutaneous fistula development after primary total laryngopharyngectomy: Results of a single-center retrospective study.

Primary total laryngopharyngectomy is the treatment of choice in many cases of locally advanced hypopharyngeal and laryngeal cancer. Development of pharyngocutaneous fistulae is the most common postoperative complication. A recent Danish study showed significantly increased rates of anastomosal leakage after colorectal resection in patients receiving diclofenac treatment. We retrospectively analyzed 67 patients after primary total laryngopharyngectomy to determine whether diclofenac increases the risk for development of pharyngocutaneous fistula analogously to leakage in the colorectal area. The fistula rate in the total study population (n = 67) was 19.4%. In the group receiving diclofenac postoperatively (n = 31), the fistula rate was 25.8%. In the patient group not receiving diclofenac (n = 36), the fistula rate was 13.9% (p = .219). Our results suggest that cyclooxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs) should be administered with caution after laryngopharyngectomy. Additional studies on larger cohorts are required to further evaluate our findings. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1515-E1520, 2016.

Importanţa utilizării alimentaţiei prin gastrostomă endoscopică percutanată în managementul pacienţilor cu neoplasme ale capului şi gâtului

Background. Nowadays the newest method of nutrition in patients with head and neck carcinomas is the use of percutaneous endoscopic gastrostomy. Aim. Since 2012 we have actively implemented the use of Nutrison administered on PEG before and after the surgical removal of laryngeal or pharyngolaryngeal carcinomas. Material and method. We conducted a prospective descriptive study on 54 cases that benefited from prophylactic PEG placement. Results. Among the cases included in our study 28 underwent total laryngectomy with bilateral removal of lymph nodes, 23 patients required pharyngo-laryngectomy, 2 cases presented invading tonsilar carcinomas and 1 case with esophageal neoplasm received PEG for palliative purpose. Conclusions. The use of PEG is cost efficient lowering the number of in hospital stay days, permits the treatment of complex cases with multiple comorbidities and actively prevents the development of pharyngocutaneous fistulae.

Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy

IntroductionPharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study's aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery. MethodsA retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n=171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed. ResultsAmerican Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model's score area under the curve was 0.76 (95% CI 0.64–0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed. ConclusionA clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement.

Pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis of risk factors.

The pharyngocutaneous fistula (PCF) is the troublesome complication after total laryngectomy. Despite a large number of investigations having been performed, there is still controversy about which factors are most significant for PCF. The objective of the present meta-analysis was to analyze the potential risk factors for PCF after total laryngectomy. Published English-language literature. PubMed, Ovid, Cochrane, and Web of Science databases were systematically searched using multiple search terms. Twenty-one studies with 3832 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence. Sixteen studies involving 2598 patients were included for the meta-analysis. The results showed that, tumor subsite (RR=0.64, 95% CI 0.47-0.88, P<0.01), T stage (RR=0.70, 95% CI 0.51-0.96, P=0.03), previous radiotherapy (RR=0.62, 95% CI 0.46-0.84, P<0.01), postoperative hemoglobin <12.5g/L (RR=0.46, 95% CI 0.27-0.76, P<0.01), and surgical margin (RR=0.41, 95% CI 0.22-0.74, P<0.01) were the risk factors associated with the development of PCF. From the results of our study, several significant risk factors for PCF are identified. Methodologically high-quality comparative studies are needed for further evaluation.

Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy.

Objectives. A pharyngocutaneous fistula (PCF) following total laryngectomy is associated with increased morbidity and severe life threatening complications. We aimed to review our experience with the PCF following total laryngectomy and determine the impact of previously reported risk factors on the development of PCF in our patients. Methods. The medical records of 20 patients who had a total laryngectomy operation were retrospectively analyzed. The association between the proposed risk factors and the incidence of the PCF was investigated. Results. Comparison of the suture techniques used for the closure of the pharynx (either continuous Cushing type or interrupted) yielded that primary interrupted sutures had a significantly higher incidence of PCF formation (p < 0.05). Although it was not statistically significant, diabetes mellitus was also associated with increased PCF formation (p > 0.05). No significant difference was observed between the PCF and non-PCF groups in terms of other proposed risk factors (p > 0.05). Conclusions. The main risk factor associated with PCF was found to be the type of pharyngeal closure technique. A vertical closure with a Cushing type continuous suture may be more successful than interrupted sutures in preventing a PCF.

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer. A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005. Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs. 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive). Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

The Impact of Pharyngeal Repair Time and Number of Sutures on Development of Pharyngocutaneous Fistula

Objectives: Pharyngocutaneous fistula (PCF) is the most common postoperative complication following total laryngectomy. The aim of this study was to determine the effects of pharyngeal repair time and number of mucosal sutures used on the development of PCF. Methods: The medical records of 47 patients who underwent total laryngectomy were assessed. The pharyngeal repair time and the number of horizontal, vertical, and cricopharyngeal muscle sutures were recorded. Results: We observed the appearance of PCF in 14 patients (29.8%). The average time for pharyngeal repair in patients without PCF was 22 minutes, 21 seconds ± 5 minutes, and the average number of vertical, horizontal, and cricopharyngeal muscle sutures was 9.54 ± 2.6, 10.84 ± 2.3, and 7.36 ± 2.7, respectively. The average time for pharyngeal repair in patients with PCF was 22 minutes 59 seconds ± 5 minutes, and the average number of vertical, horizontal, and cricopharyngeal muscle sutures was 8.57 ± 2.6, 11.14 ± 2.1, and 8.45 ± 1.9, respectively. The differences in pharyngeal repair time and number of vertical, horizontal, and cricopharyngeal sutures between the 2 groups were not statistically significant ( P &gt; .05). As the number of vertical sutures increased, the fistulas developed later ( P &lt; .05). In addition, as the number of cricopharyngeal sutures increased, the duration of the fistula decreased ( P &lt; .05). Conclusions: Surgeons should not be in a hurry when they are repairing esophageal openings, and more sutures should be used in closing the cricopharyngeal muscle to decrease the duration of PCF. Using more vertical sutures when closing the esophagus delays the onset of fistulas.

The impact of pharyngeal repair time and suture frequency on the development of pharyngocutaneous fistula after total laryngectomy.

Pharyngocutaneous fistula (PCF) is the most common postoperative complication after total laryngectomy. The aim of this study was to determine the relationship between PCF with pharyngeal repair time and the number of mucosal sutures. The medical records of 47 patients who underwent total laryngectomy were assessed prospectively. The pharyngeal repair time and the number of horizontal, vertical, and cricopharyngeal muscle sutures were recorded. We observed the occurrence of PCF in 14 patients (29.8%). The mean time for pharyngeal repair in the PCF group was 22 minutes 59 seconds ± 5 minutes, and the mean number of vertical, horizontal, and cricopharyngeal muscle sutures was 8.57 ± 2.6, 11.14 ± 2.1, and 8.45 ± 1.9, respectively. The mean time for pharyngeal repair in the non-PCF group was 22 minutes 21 seconds ± 5 minutes, and the mean number of vertical, horizontal, and cricopharyngeal muscle sutures was 9.54 ± 2.6, 10.84 ± 2.3, and 7.36 ± 2.7, respectively. The differences in the pharyngeal repair time and the number of vertical, horizontal, and cricopharyngeal sutures between the 2 groups were not statistically significant (P > 0.05). Besides, there was no statistically significant difference between the mean suture counts per centimeter in horizontal plane (1.46 ± 0.35) and vertical plane (0.98 ± 0.25) in the PCF group and the mean suture counts per centimeter in horizontal plane (1.42 ± 0.37) and vertical plane (1.13 ± 0.3) in the non-PCF group (P > 0.05). There was no relation between PCF development with pharyngeal repair time, mucosal suture count, and suture frequency after total laryngectomy.

Predictive factors for the postlaryngectomy pharyngocutaneous fistula development: systematic review

ObjectivePharyngocutaneous fistula is considered one of the major complications in the post-operative period after total laryngectomy/pharyngolaryngectomy, leading to a severe adverse impact for the patient and society. This study aimed to identify all the described pharyngocu-taneous fistula predictive factors and risk classifications. MethodsResearch was conducted to identify all the studies assessing predictive factors and risk classification for pharyngocutaneous fistula development published until April of 2012 (n=846). The included studies were analyzed and data regarding their identification, methodological quality and results were recorded. ResultsA total of 39 studies were included. The variables consistently reported as associated with fistula development were nutritional deficiency, American Society of Anesthesiologists (ASA) classification, high consumption of alcohol, anemia and hypoalbuminemia, co-morbidities, advanced N stage, location and extent of primary tumor, pre-radiotherapy and pre-chemo- radiotherapy treatment, emergency tracheotomy, surgical margin status, surgery’s duration, surgeon’s experience, local complications of the wound, performance of intraoperative blood transfusion and relationship between nasogastric tube and oral feeding. ConclusionSeveral risk factors were associated with pharyngocutaneous fistula formation in the included studies. However, there is still no consensus in the most pertinent selection. Only two classification systems were retrieved and they were not able to accurately predict pharyngocutaneous fistula.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Postoperative complications and its management after total laryngectomy

Objectives: To find out the pattern of complications, frequency, risk factors and the management after total laryngectomy. Methods: It was a cross sectional study done in the Department of Otolaryngology &amp; Head- Neck Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka from July 2007 to Dec 2009. 15 patients undergoing total laryngectomy for histologically proven Carcinoma larynx were included in this study. Patients were reviewed after surgery and any complication that occurred was recorded. The presentation, diagnosis and management of these complications were discussed after total laryngectomy. Results: There were 15 male patients, 3 non radiated cases and 12 post irradiated cases. Age of patients ranged from 35-75 years. Complications included wound infection (04), pharyngocutaneous fistula (03), flap necrosis (01), pharyngeal stenosis (01), stomal stenosis (01) and stomal recurrence (01). Conclusions: Wound infection and pharyngocutaneous fistula are most common complications after total laryngectomy. Preoperative radiotherapy is an important risk factor for development of pharyngocutaneous fistula in total laryngectomy patients. DOI: http://dx.doi.org/10.3329/bjo.v19i2.16366 Bangladesh J Otorhinolaryngol 2013; 19(2): 82-86