Hypothyroidism Predicts Fistula Development Following Salvage Oropharyngectomy

Area of Science:

• Otolaryngology
• Surgical Oncology
• Endocrinology

Background:

• Previous research linked postoperative hypothyroidism to poor wound healing in salvage laryngectomy.
• No studies have investigated this association in salvage oropharyngectomy patients.

Purpose of the Study:

• To examine the relationship between postoperative hypothyroidism and oropharyngocutaneous fistula development.
• To identify factors associated with fistula requiring reoperation after salvage oropharyngectomy.

Main Methods:

• Retrospective cohort study of 53 patients undergoing salvage oropharyngectomy for recurrent oropharyngeal squamous cell carcinoma.
• Postoperative hypothyroidism defined as thyroid-stimulating hormone (TSH) > 5.5 mIU/L.
• Multivariate analysis to assess fistula risk associated with hypothyroidism.

Main Results:

• 37.7% of patients developed postoperative hypothyroidism.
• Hypothyroid patients had a significantly higher fistula rate (35% vs. 9.1%, P=.03).
• Hypothyroidism increased fistula reoperation risk by 13.6-fold (P=.038) and fistula development by 9.5-fold (P=.013).

Conclusions:

• Postoperative hypothyroidism is a predictor of fistula development and need for operative management after salvage oropharyngectomy.
• Treatment of hypothyroidism post-surgery is recommended to mitigate wound complications.
• This finding highlights the importance of thyroid hormone management in optimizing surgical outcomes.