Radiotherapy and complications of laryngectomy

In an effort to establish factors responsible for our post laryngectomy fistulae we reviewed 357 patients who underwent total laryngectomy between 1965 and 1990, for laryngeal carcinoma. Pharyngocutaneous fistulae occurred in 84 cases (23 per cent). There was no difference between the fistula group and the non-fistula group with regard to age, sex, general condition, or tumour differentiation. The only significant, positive association was with previous radical radiotherapy (10 fistulae out of 167 primary laryngectomies (4 per cent) versus 74 fistulae out of 190 salvage laryngectomies (39 per cent)). The median time to occurrence of a fistula was day seven in both groups. However, in the non-radiotherapy group the median duration of the fistula was 28 days; the majority healing spontaneously, with only one patient requiring surgical closure. There were no 'hospital' deaths. In the radiotherapy group the median duration of fistulae was 112 days with 30 patients requiring a total of 66 procedures to achieve closure of the fistula. There were six 'hospital' deaths in this group. We conclude that previous radical radiotherapy strongly predisposes towards the occurrence of a post-laryngectomy fistula. Fistulae in this group tend to be longer lasting and are more likely to require surgical repair.