Objectives:
Our aim was to determine the incidence and the etiologic factors predisposing to the formation of pharyngocutaneous fistulas after total laryngectomy.
Material and Methods:
The records of 31 male patients who underwent total laryngectomy for squamous cell carcinoma between July 2001 and February 2004 were reviewed retrospectively. Ten risk factors (age, smoking, chronic systemic diseases, postoperative hemoglobin and preoperative albumin levels, localization, differentiation and stage of the tumor, concurrent neck dissection, method of pharyngeal closure) and the incidence of pharyngocutaneous fistulas were assessed together with durations of fistula occurrence and hospitalization.
Results:
Mean age of the patients was 55.7 years ranging from 42 to 72. A pharyngocutaneous fistula developed in 12 patients (38.7%) within a mean time of 7.8 days (range 5 to 11 days) postoperatively. Patients’ age, smoking habits, the tumor stage, exact localization of the tumor and the degree of differentiation didn’t show any statistical significant relationship with the formation of postoperative fistulas. Diabetes mellitus, postoperative anemia, hypoproteinemia, the closure of pharynx in T shape and concurrent neck dissection were found to be statistically significant risk factors for pharyngocutaneous fistula formation. The mean hospitalization time of the patients with pharyngocutaneous fistula was 30.4 days (between 21 to 48 days).
Conclusion:
Diabetes mellitus, postoperative anemia, hypoproteinemia, the closure of pharynx in T shape and concurrent neck dissection are the risk factors for pharyngocutaneous fistula formation. Postoperative pharyngocutaneous fistulas significantly increase patients’ morbidity, hospitalization time and delay initiation of postoperative radiation therapy where indicated.
Keywords: Pharyngocutaneous fistula, total laryngectomy, complication