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Pharyngocutaneous Fistula Following Total Laryngectomy: a High-Volume Tertiary Centre Series

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Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding risk factors for fistula development. A standard score for fistula prediction is lacking. Study population included all patients submitted to total laryngectomy (with or without pharyngectomy) due to laryngeal or hypopharyngeal tumours, occurring between January 1st, 2012, and December 31st, 2016. Patient demographics were recorded as well as disease and treatment variables. Statistical analysis was performed using the IBM SPSS Statistics 25®. A previously described predictive model for fistula occurrence was applied. A total of 212 patients were included, the vast majority with advanced local disease (97.5%). Only 10% were submitted to rescue surgery. Fistula incidence was 39.9%. Our rates of locally advanced tumours, with extensive hypopharyngeal involvement, were higher than in most series. Age, tumour location, diabetes, previous chemoradiotherapy, advanced local and regional disease, extensive pharyngectomy, flap reconstruction, manual suture and low post-operative albumin level were associated to fistula occurrence on univariate analysis. Only salvage surgery and advanced local disease remained significant on multivariate analysis. An adapted Cecatto score correlated with fistula occurrence but has not achieved statistical significance. Predictive models for fistula occurrence are lacking. Cecatto score showed promising results in our population but large multicentric studies are necessary for cut-off adjustments.

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Authors and Affiliations

  1. Otorhinolaryngology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal

    José Ferreira Penêda

  2. Otorhinolaryngology Department, Instituto Português de Oncologia do Porto–Francisco Gentil (IPOP FG), Porto, Portugal

    João Fernandes & Eurico Monteiro

Authors
  1. José Ferreira Penêda
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  2. João Fernandes
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  3. Eurico Monteiro
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Contributions

First author designed the study, collected data and drafted the article. Second and third authors reviewed the draft. First author re-wrote the draft till a consensus was reached. All authors approved the final version.

Corresponding author

Correspondence to José Ferreira Penêda.

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Ethics Approval and Consent to Participate

Retrospective study developed at Instituto Português de Oncologia do Porto–Francisco Gentil (IPOP FG), Porto, Portugal. No ethical approval was considered necessary.

Competing Interests

The authors declare no competing interests.

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Key Points

• Fistula incidence following total laryngectomy remains a common complication.

• There is also no consensus regarding risk stratification and no predictive score is widely used.

• We provide a large series from an Oncology dedicated hospital and compare our results to other series. The authors also applied a previously descripted predictive rule for fistula occurrence.

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Penêda, J.F., Fernandes, J. & Monteiro, E. Pharyngocutaneous Fistula Following Total Laryngectomy: a High-Volume Tertiary Centre Series. Indian J Surg Oncol 14, 742–748 (2023). https://doi.org/10.1007/s13193-023-01765-1

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  • DOI: https://doi.org/10.1007/s13193-023-01765-1

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