TY - JOUR
T1 - Pharyngocutaneous fistula after total laryngectomy
T2 - A single-institution experience, 2001-2012
AU - Benson, Eleni M.
AU - Hirata, Richard M.
AU - Thompson, Carol B.
AU - Ha, Patrick K.
AU - Fakhry, Carole
AU - Saunders, John R.
AU - Califano, Joseph A.
AU - Arnaoutakis, Demetri
AU - Levine, Marshall
AU - Tang, Mei
AU - Neuner, Geoffrey
AU - Messing, Barbara P.
AU - Blanco, Ray G.F.
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Purpose The purpose of this study was to determine the incidence of and risk factors for pharyngocutaneous fistula in patients undergoing total laryngectomy at a single institution. Materials and methods The records of 59 patients undergoing primary or salvage total laryngectomy at our institution from 2001 to 2012 were retrospectively reviewed. Data collected included patient, tumor and treatment characteristics, and surgical technique. Risk factors were analyzed for association with pharyngocutaneous fistula formation. Results Twenty patients (34%) developed fistulas. Preoperative tracheostomy (OR 4.1; 95% CI 1.3-13 [p = 0.02]) and low postoperative hemoglobin (OR 9.1; 95% CI 1.1-78 [p = 0.04]) were associated with fistula development. Regarding surgical technique, primary sutured closure of the total laryngectomy defect had the lowest fistula rate (11%). In comparison, primary stapled closure and pectoralis onlay flap over primary closure had nonsignificantly increased fistula rates (43%, OR 6.0; 95% CI 1.0-37.3 [p = 0.06] and 25%, OR 2.7; 95% CI 0.4-23.9 [p = 0.38], respectively). Pectoralis flap incorporated into the suture line had a significantly increased fistula rate (50%, OR 7.1; 95% CI 1.4-46 [p = 0.02]). After stratification for salvage status, patient comorbidities were associated with fistula in non-salvage cases whereas disease-related characteristics were associated with fistula in salvage cases. Fistula development was associated with increased length of hospital stay (p < 0.001) and increased time before oral diet initiation (p < 0.001). Conclusions Pharyngocutaneous fistula is a common complication of total laryngectomy. Preoperative tracheostomy, postoperative hemoglobin, and surgical technique are important in determining the risk of fistula.
AB - Purpose The purpose of this study was to determine the incidence of and risk factors for pharyngocutaneous fistula in patients undergoing total laryngectomy at a single institution. Materials and methods The records of 59 patients undergoing primary or salvage total laryngectomy at our institution from 2001 to 2012 were retrospectively reviewed. Data collected included patient, tumor and treatment characteristics, and surgical technique. Risk factors were analyzed for association with pharyngocutaneous fistula formation. Results Twenty patients (34%) developed fistulas. Preoperative tracheostomy (OR 4.1; 95% CI 1.3-13 [p = 0.02]) and low postoperative hemoglobin (OR 9.1; 95% CI 1.1-78 [p = 0.04]) were associated with fistula development. Regarding surgical technique, primary sutured closure of the total laryngectomy defect had the lowest fistula rate (11%). In comparison, primary stapled closure and pectoralis onlay flap over primary closure had nonsignificantly increased fistula rates (43%, OR 6.0; 95% CI 1.0-37.3 [p = 0.06] and 25%, OR 2.7; 95% CI 0.4-23.9 [p = 0.38], respectively). Pectoralis flap incorporated into the suture line had a significantly increased fistula rate (50%, OR 7.1; 95% CI 1.4-46 [p = 0.02]). After stratification for salvage status, patient comorbidities were associated with fistula in non-salvage cases whereas disease-related characteristics were associated with fistula in salvage cases. Fistula development was associated with increased length of hospital stay (p < 0.001) and increased time before oral diet initiation (p < 0.001). Conclusions Pharyngocutaneous fistula is a common complication of total laryngectomy. Preoperative tracheostomy, postoperative hemoglobin, and surgical technique are important in determining the risk of fistula.
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U2 - 10.1016/j.amjoto.2014.08.017
DO - 10.1016/j.amjoto.2014.08.017
M3 - Article
C2 - 25245411
AN - SCOPUS:84920736181
SN - 0196-0709
VL - 36
SP - 24
EP - 31
JO - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
JF - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
IS - 1
ER -