Risk factors of pharyngocutaneous fistula after total laryngectomy: a systematic review and meta-analysis

  • Maohua Wang
  • Youfang Xun
  • Kaijian Wang
  • Ling Lu
  • Aimin Yu
  • Bing GuanEmail author
  • Chenjie YuEmail author
Head and Neck



The purpose of this study was to systematically evaluate the risk factors of pharyngocutaneous fistula (PCF) after total laryngectomy.


We systematically searched Pubmed, Web of Science, Cochrane Library, and Embase databases and included the literature according to the inclusion and exclusion criteria.


A total of 52 studies with 8605 patients were included in the meta-analysis. The total incidence of PCF was 21% (1808/8605). Meta-analysis results indicated that age (OR = 1.29, 95% CI 1.06–1.58, P = 0.01), smoking (OR = 1.62, 95% CI 1.27–2.07, P < 0.01), COPD (chronic obstructive pulmonary disease) (OR = 1.62, 95% CI 1.19–2.22, P < 0.01), CAD (coronary atherosclerotic heart disease) (OR = 1.82, 95% CI 1.36–2.45, P < 0.01), T-stage (OR = 0.81, 95% CI 0.67–0.98, P = 0.03), previous radiotherapy (OR = 2.41, 95% CI 2.00–2.90, P < 0.01), preoperative albumin (OR = 2.95, 95% CI 1.47–5.91, P < 0.01), preoperative hemoglobin (OR = 1.97, 95% CI 1.28–3.03, P < 0.01), tumor site (OR = 0.28, 95% CI 0.22–0.36, P < 0.01), and treatment method (OR = 1.85, 95% CI 1.44–2.38, P < 0.01) were risk factors associated with PCF.


In our study, age, smoking, COPD, CAD, T-stage, previous radiotherapy, preoperative albumin, preoperative hemoglobin, tumor site, and treatment method were risk factors of PCF.


Pharyngocutaneous fistula Total laryngectomy Risk factor Laryngeal cancer Meta-analysis 



We would like to thank Professors Bing Guan and Chenjie Yu for reviewing and providing advice on the final search strategy. We thank LetPub ( for its linguistic assistance during the preparation of this manuscript.


This work was supported by grants from Nanjing Medical Science and Technique Development Foundation (No. QRX17051). The Project of Invigorating Health Care through Science, Technology and Education (No. ZDXKB2016015).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology, Head and Neck Surgery, XiangYa School of MedicineCentral South UniversityChangshaPeople’s Republic of China
  2. 2.Department of Otolaryngology, Head and Neck SurgeryClinical Medical College of Yangzhou UniversityYangzhouPeople’s Republic of China
  3. 3.Department of Otolaryngology, Head and Neck Surgery, Drum Tower Clinical Medical CollegeNanjing Medical UniversityNanjingPeople’s Republic of China
  4. 4.Department of Otolaryngology, Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical SchoolJiangsu Provincial Key Medical Discipline (Laboratory)NanjingPeople’s Republic of China
  5. 5.Research Institute of OtolaryngologyNanjingPeople’s Republic of China

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