The Incidence and the Risk Factors for Pharyngocutaneous Fistula following Primary and Salvage Total Laryngectomy

SIMPLE SUMMARY: The pharyngocutaneous fistula is the most common surgical complication following total laryngectomy. It is an abnormal canal connecting the pharyngeal canal and the skin of the neck. It has been associated with many undesirable consequences not only for the surgeon and patient but also from the economic point of view. However, many controversies still remain. Our aim was to analyse the incidence and risk factors in a large study set collected over a longer period of time. Four hundred twenty-two patients were included. The incidence was 23.9% and the risk factors included surgical wound infection, piriform sinus invasion, laryngectomy following previous (chemo)radiation and total radiation dose. With the prevention of the modifiable risk factors, we can lower the rate at which the fistula occurs. In this regard, we find surgical wound infection to be of the utmost importance as it can be directly influenced. ABSTRACT: The pharyngocutaneous fistula (PCF) is the most common complication following a total laryngectomy (TL) with a wide range of incidence and various potential risk factors. The aim was to analyse the incidence and potential risk factors for PCF formation in a large study set collected over a longer period of time. In the retrospective study at the Department of Otorhinolaryngology and Cervicofacial Surgery of Ljubljana, 422 patients who were treated for head and neck cancer by TL between 2007 and 2020 were included. The comprehensive clinicopathologic data were collected including potential risk factors related to the patient, disease, surgical treatment and post-operative period for the development of fistulae. The patients were categorized into a group with the fistula (a study group) and one without it (a control group). The PCF then developed in 23.9% of patients. The incidence following a primary TL was 20.8% and 32.7% following salvage TL (p = 0.012). The results demonstrated that surgical wound infection, piriform sinus invasion, salvage TL, and total radiation dose were determined as independent risk factors for PCF formation. A diminishing surgical wound infection rate would contribute to a further reduction of the PCF rate.