Predictive factors for the postlaryngectomy pharyngocutaneous fistula development: systematic review

OBJECTIVE: Pharyngocutaneous fistula is considered one of the major complications in the post-operative period after total laryngectomy/pharyngolaryngectomy, leading to a severe adverse impact for the patient and society. This study aimed to identify all the described pharyngocu-taneous fistula predictive factors and risk classifications. METHODS: Research was conducted to identify all the studies assessing predictive factors and risk classification for pharyngocutaneous fistula development published until April of 2012 (n = 846). The included studies were analyzed and data regarding their identification, methodological quality and results were recorded. RESULTS: A total of 39 studies were included. The variables consistently reported as associated with fistula development were nutritional deficiency, American Society of Anesthesiologists (ASA) classification, high consumption of alcohol, anemia and hypoalbuminemia, co-morbidities, advanced N stage, location and extent of primary tumor, pre-radiotherapy and pre-chemo- radiotherapy treatment, emergency tracheotomy, surgical margin status, surgery’s duration, surgeon’s experience, local complications of the wound, performance of intraoperative blood transfusion and relationship between nasogastric tube and oral feeding. CONCLUSION: Several risk factors were associated with pharyngocutaneous fistula formation in the included studies. However, there is still no consensus in the most pertinent selection. Only two classification systems were retrieved and they were not able to accurately predict pharyngocutaneous fistula. © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.