Risk Factors of Pharyngocutaneous Fistula Following Primary and Salvage Total Laryngectomy

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.

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.

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.

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.