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Improved Early Detection Models of Pharyngocutaneous Fistula after Total Laryngectomy
Yujin Heo1, Hyun Suk Lee2, Sungha Jung1
1Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Insights
Early detection of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) is crucial. New predictive models combining fistulography with specific blood markers show improved accuracy for early PCF detection, potentially preventing fatal complications.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Medical Diagnostics
Background:
- Pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy (TL).
- Early detection of PCF is vital to prevent severe outcomes like major vessel rupture.
Purpose of the Study:
- To develop and validate predictive models for early detection of PCF post-TL.
- To identify key clinical and laboratory factors associated with PCF development.
Main Methods:
- Retrospective analysis of 263 patients undergoing TL.
- Collection of clinical data including fever, blood tests (WBC, CRP, albumin, Hb, neutrophils, lymphocytes) on postoperative days (POD) 3 and 7, and fistulography on POD 7.
- Machine learning applied to identify significant predictive factors for PCF.
Main Results:
- PCF occurred in 32.7% of patients.
- Fever and elevated WBC, CRP, neutrophil, and NLR ratios (POD 7/3) were significantly higher in the fistula group (p < 0.001).
- Combined predictive models (fistulography, POD 7 WBC, neutrophil ratio) achieved an AUC of 0.83, outperforming fistulography alone (AUC 0.68).
Conclusions:
- Developed predictive models demonstrate enhanced accuracy for early PCF detection.
- These models may significantly reduce fatal complications associated with PCF after TL.
- Integration of clinical and laboratory data improves diagnostic performance for PCF.
Abstract:
Early detection of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) could prevent severe complications such as major vessel rupture. We aimed to develop prediction models for detecting PCF in the early postoperative period. We retrospectively analyzed patients (N = 263) who received TL between 2004 and 2021. We collected clinical data for fever (>38.0 °C) and blood tests (WBC, CRP, albumin, Hb, neutrophils, lymphocytes) on postoperative days (POD) 3 and 7, and fistulography on POD 7. Clinical data were compared between fistula and no fistula groups, and significant factors were selected using machine learning. Using these clinical factors, we developed improved prediction models for PCF detection. Fistula occurred in 86 (32.7%) patients. Fever was significantly (p < 0.001) more common in the fistula group, and ratios (POD 7 to 3) of WBC, CRP, neutrophils, and neutrophils-to-lymphocytes (NLR) were significantly higher (all p ≤ 0.001) in the fistula group than in the no fistula group. Leakage on fistulography was more common in the fistula group (38.2%) than in the no fistula group (3.0%). The area under curve (AUC) of fistulography alone was 0.68, but predictive models using a combination of fistulography, WBC at POD 7, and neutrophil ratio (POD 7/POD 3) showed better diagnostic performance (AUC of 0.83). Our predictive models may detect PCF early and accurately, which could reduce fatal complications following PCF.
