Contrast Swallow for Detecting Pharyngocutaneous Fistula After Total Laryngectomy: A Systematic Review

Area of Science:

• Otolaryngology
• Radiology
• Surgical Oncology

Background:

• Pharyngocutaneous fistula (PCF) is a complication following laryngectomy.
• Accurate and timely diagnosis of PCF is crucial for patient management and recovery.

Purpose of the Study:

• To evaluate the diagnostic performance of contrast swallow for identifying PCF post-laryngectomy.
• To assess the sensitivity, specificity, and predictive values of contrast swallow in PCF detection.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, and PubMed.
• Inclusion of 13 studies (1979-2022) involving 1456 patients who underwent laryngectomy and had PCF assessment.
• Extraction of diagnostic accuracy data, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Main Results:

• Contrast swallow demonstrated wide ranges in diagnostic accuracy: sensitivity (0.26-1.00), specificity (0.55-0.99), PPV (0.14-0.85), and NPV (0.75-1.00).
• Significant variability in reported performance suggests overall poor diagnostic utility.
• High false positive rates were observed, potentially delaying oral feeding initiation.

Conclusions:

• The diagnostic accuracy of contrast swallow for PCF is highly variable and generally poor.
• The utility of contrast swallow as a primary screening tool for PCF is questionable due to its limitations.
• Further research is needed to establish superior diagnostic pathways for PCF detection.