Pharyngocutaneous fistula after total laryngectomy
Reviewed by Sunil Sharma

Pharyngocutaneous fistula (PCF) after total laryngectomy is a serious complication post-surgery, and can lead to prolonged hospitalisation, adding delays in postoperative chemoradiotherapy. This Turkish retrospective study looked at 166 patients who underwent total laryngectomy for laryngeal cancer, although it is not clear what time period this was over. They looked at 32 individual risk factors thought to contribute to the development of PCF post laryngectomy. In summary, they found that age >61 years, diabetes, preoperative radiotherapy, preoperative tracheostomy, low postoperative albumin and haemoglobin levels, and postoperative infection (evidenced by temperature >38 degrees), were considered to have a statistically significant effect on the development of PCF by multivariate logistic regression analysis. They also found an association of advanced disease on T staging, concurrent bilateral neck dissection, T-shaped pharyngeal closure and presence of postoperative depression with PCF, although it is not clear whether there could be confounding factors associated with this. Their incidence of PCF (19.2%) was comparable to previously published literature. This paper provides a comprehensive review of one institution’s experience with PCF, and reinforces the idea that preoperative nutritional and psychiatric support, regulating metabolic parameters postoperatively, and concurrent flap reconstruction helps to reduce the incidence of PCF.

Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches.
Kilic C, Tuncel U, Comert E.
B-ENT
2015;11:95-100.