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Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy
José Ferreira Penêda1, João Fernandes2, Eurico Monteiro2
1Otorhinolaryngology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal.
Summary
Pharyngocutaneous fistula is a common complication after total laryngectomy. Patients undergoing salvage surgery for advanced disease appear to be at higher risk, but consensus on other risk factors remains elusive.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Medical Literature Analysis
Background:
- Pharyngocutaneous fistula is the primary complication post-total laryngectomy.
- High fistula incidence persists despite advancements in medical care.
- There is no established consensus on identifying patients at higher risk for fistula development.
Purpose of the Study:
- To conduct a literature review identifying risk factors for pharyngocutaneous fistula development after total laryngectomy.
- To synthesize current evidence on patient risk stratification for this complication.
Main Methods:
- Systematic search of the PUBMED database using MESH terms 'larynx cancer' and 'fistula' (2014-2019).
- Inclusion of English and Portuguese articles, excluding animal studies and case reports.
- Analysis of 151 abstracts, 82 full texts, with a final selection of 50 studies (reviews, retrospective, and prospective analyses).
Main Results:
- No definitive consensus exists regarding specific risk factors for fistula development.
- Patients undergoing salvage surgery for advanced laryngeal cancer appear to have an increased risk.
- Nutritional status is a logical contributor, but a definitive marker is lacking; inconsistently reported variables should be disregarded without further proof.
Conclusions:
- Current evidence does not support a consensus on risk factors for pharyngocutaneous fistula post-total laryngectomy.
- Salvage surgery for advanced disease is a potential risk factor requiring further investigation.
- Standardized risk assessment scores for fistula occurrence are needed due to its commonality.
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