Skip to main content
SpringerLink
Log in

Mapping the Risk Factors of Pharyngocutaneous Fistula After Salvage Laryngectomies

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

To evaluate the postoperative surgical wound infection prevalence rates of patients undergoing SL, identify the causative organism and determine predisposing factors leading to infection. A retrospective study of all consecutive patients who underwent salvage total laryngectomy at our unit between 2015 and 2020 was performed. The following parameters were also analyzed: age, smoking history, pre and postoperative albumin level, history of radio and chemo-radiotherapy, reconstruction with pectoralis flap, intraoperative tracheoesophageal puncture, and tumor stage. A total of 12 of the 21 patients (57%) experienced a postoperative infection after SL during the study period. 82% of those patients whose preoperative albumin level below 3gm/dl developed postoperative infection. There is a significant increase (p < 0.01) in infection in patients with N1 and 2 stage tumor (68%) compared with the N0 stage tumors (40%). Multivariate analysis showed that preoperative albumin and nodal stage were significant risk factors for postoperative infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

All data generated or analysed during this study had already been included in this manuscript. Patient’s case file was retrieved from the medical record section of the institution. The clinical data had been collected from the prospectively maintained computerized database and the case file. The follow-up status was updated from the above-mentioned manner.

References

  1. Murdoch DA, Telfer MR, Irvine GH (1993) Audit of antibiotic policy and wound infection in neck surgery. J R Coll Surg Edinb 38:167–1692

    CAS  Google Scholar 

  2. Tabet JC, Johnson JT (1990) Wound-infection in head and neck-surgery—prophylaxis, etiology and management. J Otolaryngol 19:197–2003

    CAS  Google Scholar 

  3. Scher KS, Bernstein JM, Arenstein GL, Sorensen C (1990) Reducing the cost of surgical prophylaxis. Am Surg 56:32–35

    CAS  Google Scholar 

  4. Ifeacho SN, Bajaj Y, Jephson CG, Albert DM (2012) Surgical siteinfections in paediatric otolaryngology operative procedures. Int J Pediatr Otorhinolaryngol 76:1020–1022

    Article  CAS  Google Scholar 

  5. Lotfi CJ, Cavalcanti Rde C, Costa e Silva AM et al (2008) Risk fac-tors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg. 138:74–80

    Article  Google Scholar 

  6. Ogihara H, Takeuchi K, Majima Y (2009) Risk factors of post-operative infection in head and neck surgery. Auris Nasus Larynx 36:457–4605

    Article  Google Scholar 

  7. Grandis JR, Snyderman CH, Johnson JT, Yu VL, Damico F (1992) Post-operative wound-infection—a poor prognostic sign for patients with head and neck cancer. Cancer 70:2166–21706

    Article  CAS  Google Scholar 

  8. Simo R, French G (2006) The use of prophylactic antibiotics in head and neck oncological surgery. Curr Opin Otolaryngol Head Neck Surg 14:55–617

    Article  Google Scholar 

  9. Weber RS, Callender DL (1992) Antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery. Ann Otol Rhinolaryngology Suppl 155:16–208

    CAS  Google Scholar 

  10. Swift AC (1988) Wound sepsis, chemoprophylaxis and major head and neck-surgery. Clin Otolaryngol 13:81–83

    Article  CAS  Google Scholar 

  11. Becker GD, Parell GJ (1979) Cefazolin prophylaxis in head andneck-cancer surgery. Ann Otol Rhinol Laryngol 88:183–186

    Article  CAS  Google Scholar 

  12. Scottish Intercollegiate Guidelines Network (SIGN) (2008) Publication number 104: antibiotic prophylaxis in surgery: a national clinical guideline. Health Improv Scotlhttp://www.sign.ac.uk/pdf/sign104.pdf

  13. Penel N, Lefebvre D, Fournier C, Sarini J, Kara A, Lefebvre JL (2001) Risk factors for wound infection in head and neck cancer surgery: a prospective study. Head Neck 23(6):447–45511

    Article  CAS  Google Scholar 

  14. Velanovich V (1991) A meta-analysis of prophylactic antibiotics in head and neck surgery. Plast Reconstr Surg 87(3):429–434

    Article  CAS  Google Scholar 

  15. Sassler AM, Esclamado RM, Wolf GT (1995) Surgery after organ preservation therapy analysis of wound complications. Arch Otolaryngol Head Neck Surg 121:162–165

    Article  CAS  Google Scholar 

  16. Sundaram K, Wasserman JM (2009) Prevention of unplanned pharyngocutaneous fistula in salvage laryngectomy. Otolaryngol Head Neck Surg 141:645–647

    Article  Google Scholar 

  17. Qureshi SS, Chaturvedi P, Pai PS, Chaukar DA, Deshpande MS, Pathak KA, D’cruz AK (2005) A prospective study of pharyngocutaneous fistulas following total laryngectomy. J Cancer Res Ther 1(1):51

    Article  CAS  Google Scholar 

  18. Berrios-Torres SI, Umscheid CA, Bratzler DW et al (2017) Centers or Disease Control and Prevention guideline for the prevention of surgical site infection. JAMA Surg. 152:784–791

    Article  Google Scholar 

  19. Kwon D, Genden EM, de Bree R, Rodrigo JP, Rinaldo A, Sanabria A, Rapidis AD, Takes RP, Ferlito A (2018) Overcoming wound complications in head and neck salvage surgery. Auris Nasus Larynx 45(6):1135–1142

    Article  Google Scholar 

  20. Weber RS, Berkey BA, Forastiere A, Cooper J, Maor M, Goepfert H, Morrison W, Glisson B, Trotti A, Ridge JA, Chao KSC, Peters G, Lee DJ, Leaf A, Ensley J (2003) Outcome of salvage total laryngectomy following organ preservation therapy. the radiation therapy oncology group trial 91–11. Arch Otolaryngology Head Neck Surg 129:44–49

    Article  Google Scholar 

  21. Park SY, Kim MS, Eom JS, Lee JS, Rho YS (2016) Risk factors and etiology of surgical site infection after radical neck dissection in patients with head and neck cancer. Korean J Intern Med 31(1):162

    Article  Google Scholar 

  22. Wakisaka N, Murono S, Kondo S, Furukawa M, Yoshizaki T (2008) Post-operative pharyngocutaneous fistula after laryngectomy. Auris Nasus Larynx 35:203–208

    Article  Google Scholar 

  23. Scotton W, Cobb R, Pang L, Nixon I, Joshi A, Jeannon JP, Oakley R, French G, Hemsley C, Simo R (2012) Post-operative wound infection in salvage laryngectomy: does antibiotic prophylaxis have an impact? Eur Arch Otorhinolaryngol 269(11):2415–2422

    Article  Google Scholar 

  24. Coskun H, Erisen L, Basut O (2000) Factors affecting wound infection rates in head and neck surgery. Otolaryngology-Head and Neck Surgery 123(3):328–333

    Article  CAS  Google Scholar 

  25. Mebeed AH, Hussein HA, Saber TKh, Zohairy MA, Lotayef M (2009) Role of pectoralis major myocutanuos flap in salvage laryngeal surgery for prophylaxis of pharyngocutaneuos fistula and reconstruction of skin defect. J Egypt Natl Canc Inst 21(1):23–32 (PMID: 20601968)

    Google Scholar 

  26. Hirakawa H, Hasegawa Y, Hanai N, Ozawa T, Hyodo I, Suzuki M (2013) Surgical site infection in clean-contaminated head and neck cancer surgery: risk factors and prognosis. Eur Arch Otorhinolaryngol 270:1115–1123

    Article  Google Scholar 

  27. Jeannon JP, Orabi A, Manganaris A, Simo R (2010) Methicillin Resistant Staphylococcus Aureus Infection as a causative agent of fistula formation following total laryngectomy for advanced head & neck cancer. Head Neck Oncol 2(1):1–5

    Article  Google Scholar 

Download references

Funding

This research did not receive any special grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. The Otolaryngology Department, Faculty of Medicine, Cairo University, Cairo, Arab Republic of Egypt

    Ahmed Amin Nassar

  2. 4 Mohamed Yousef Othman ST, Omraneya, Giza, 12552, Al zohour district, Egypt

    Ahmed Amin Nassar

Authors
  1. Ahmed Amin Nassar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AAN; made substantial contributions to the data collection, and manuscript writing and gave final approval of the manuscript version to be published. The author read and approved the final manuscript.

Corresponding author

Correspondence to Ahmed Amin Nassar.

Ethics declarations

Conflict of interest

The authors do not have any conflict of interest to declare.

Consent for publication

Written informed consent to publish the patient’s clinical details information was obtained from the study participant.

Ethics approval and consent to participate

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 21 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nassar, A.A. Mapping the Risk Factors of Pharyngocutaneous Fistula After Salvage Laryngectomies. Indian J Otolaryngol Head Neck Surg 74 (Suppl 3), 5954–5958 (2022). https://doi.org/10.1007/s12070-021-02603-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-021-02603-y

Keywords

Search

Navigation