Pharyngocutaneous Fistula Following Primary and Salvage Laryngectomy: Aetiology and Predictive Factors

Risk Factors of Pharyngocutaneous Fistula Following Primary and Salvage Total Laryngectomy

OBJECTIVES

Pharyngocutaneous fistula (PCF) is the most frequent complication following total laryngectomy (TL). Its incidence increases in the presence of multiple risk factors related to the patient, the tumor, and the surgical procedure. Our study aimed to determine the incidence of PCF and its risk factors.

METHODS

We performed a retrospective study including patients who underwent primary TL (PTL) or salvage TL (STL) between 2007 and 2023. We studied the factors that increased the risk of PCF occurrence, thar are related to the patient, the disease, and the received treatment.

RESULTS

We included 132 patients with a male-to-female ratio of 32, who received PTL (91%) or STL (9%). The tumor was staged as T4a in 62% of patients. PCF occurred in 17 patients (13%) after a median of 14 days (5-36). PCF was managed conservatively in 13 patients (76%), while a surgical re-suture was required in four patients (24%).In the univariate analysis, preoperative anemia, STL, widened forward TL, wound infection, and preoperative hypoproteinemia were significantly associated with PCF. In the multivariate analysis, preoperative anemia (P = .012), wound infection (P = .049), and STL (P = .005) were risk factors of PCF. At the multivariate analysis, preoperative anemia [P = .012, odds ratio (OR) = 6.9], wound infection (P = .049, OR = 6.5), and STL (P = .005, OR = 18.45) were independent risk factors of PCF.

CONCLUSION

We demonstrated that preoperative anemia, wound infection, and STL were independent risk factors of PCF following TL. Avoiding these circumstances can help prevent PCF occurrence.

Management of pharyngocutaneous fistula following laryngectomy with autologous fat graft: A case report and literature review

INTRODUCTION AND SIGNIFICANCE

Pharyngocutaneous fistula (PCF) is a serious complication following total laryngectomy, significantly impacting patients' quality of life and treatment costs. Management is complex, with potential for recurrence after surgical intervention.

CASE PRESENTATION

We present a case of PCF that developed following laryngectomy. Initial conservative treatment failed to resolve the fistula. A pectoralis major myofascial flap was then attempted, but the fistula recurred. Finally, autologous fat grafting was performed with excellent results.

CLINICAL DISCUSSION

Conservative management should be the first-line approach for PCF, as most cases respond favorably. However, if the fistula persists, alternative methods should be explored to achieve optimal outcomes. Our case highlights the importance of not persisting with a failed approach. Autologous fat grafting offers a promising alternative with demonstrably positive outcomes.

CONCLUSION

Pharyngocutaneous fistula presents a significant challenge in post-laryngectomy care. Surgical repair can be complex with potential complications. Our case demonstrates the effectiveness of autologous fat grafting as a successful treatment modality.

Risk factors and healing factors for pharyngocutaneous fistula after total laryngectomy for laryngeal cancer: An epidemiological study

To analyse the risk factors and healing factors of pharyngocutaneous fistula (PCF) in patients with laryngeal cancer after total laryngectomy, and to explore the relevant epidemiology. A retrospective analysis was conducted on laryngeal cancer patients who underwent total laryngectomy in our hospital from January 2010 to December 2022. The 349 patients included in the study were divided into a PCF group of 79 and a non-PCF group of 270. Perform one-way analysis of variance and multivariate logistic analysis on various data of patients included in the statistics, and analyse the risk factors and healing factors of PCF. Smoking, history of radiation therapy for laryngeal cancer, history of chemotherapy for laryngeal cancer, tumour location (larynx, pharynx, oesophagus), preoperative albumin, postoperative proteinaemia, <99 haemoglobin, postoperative haemoglobin, postoperative C-reactive protein (CRP) level are the risk factors for PCF. Also, radiation therapy and postoperative proteinaemia were the main reasons for preventing PCF healing. Smoking history, laryngeal cancer, radiation therapy, albumin, haemoglobin and CRP are risk factors for postoperative PCF after total laryngectomy, while radiation therapy and postoperative hypoalbuminaemia are key factors affecting PCF healing.

The Localisation of a Tracheoesophageal Shunt during Laryn(-gopharyn)gectomy Determines the Risk of Shunt Insufficiency

BACKGROUND

Tracheoesophageal shunt insufficiency (TESI) is a common and potentially life-threatening complication after laryn(-gopharyn)gectomy (L(P)E). We investigated whether TESI could be the result of a specific shunt location.

METHODS

A monocentric, retrospective cohort analysis of 171 consecutively treated L(P)E patients was performed. Patients with a secondary prosthesis instillation and patients with insufficient postoperative imaging were excluded. Disease related data as well as location of primary voice prosthesis were assessed.

RESULTS

The cohort was divided into 62 TESI-positive and 109 TESI-negative individuals. The mean time from surgery to TESI was 32 months. No differences were observed in gender, age, tumor localization, T/R/M-status. Surgery without adjuvant therapy was more often performed in TESI-negative individuals when compared with their positive counterparts. However, Cox regression including T/N status, therapy and categorized distance of the tracheoesophageal shunt to the manubrium (≤1.5 cm vs. >1.5 cm) revealed that a distance of ≤1.5 cm was associated with a 2.1-fold increased risk of TESI, while all other parameters did not influence the event-free survival.

CONCLUSIONS

Primary shunt positioning ≤1.5 cm to the ridge of the manubrium is associated with an increased risk of TESI. In these individuals secondary shunt operation resulting in a position >1.5 cm distant to the manubrium should be recommended.

The Incidence and the Risk Factors for Pharyngocutaneous Fistula following Primary and Salvage Total Laryngectomy

The pharyngocutaneous fistula (PCF) is the most common complication following a total laryngectomy (TL) with a wide range of incidence and various potential risk factors. The aim was to analyse the incidence and potential risk factors for PCF formation in a large study set collected over a longer period of time. In the retrospective study at the Department of Otorhinolaryngology and Cervicofacial Surgery of Ljubljana, 422 patients who were treated for head and neck cancer by TL between 2007 and 2020 were included. The comprehensive clinicopathologic data were collected including potential risk factors related to the patient, disease, surgical treatment and post-operative period for the development of fistulae. The patients were categorized into a group with the fistula (a study group) and one without it (a control group). The PCF then developed in 23.9% of patients. The incidence following a primary TL was 20.8% and 32.7% following salvage TL (p = 0.012). The results demonstrated that surgical wound infection, piriform sinus invasion, salvage TL, and total radiation dose were determined as independent risk factors for PCF formation. A diminishing surgical wound infection rate would contribute to a further reduction of the PCF rate.