Pharyngo-cutaneous fistula formation following total laryngectomy:
management, sequelae and outcomes
Abstract
Objective: To describe our experience of dealing with pharyngocutaneous
fistulas (PCF) following total laryngectomy. Design: Retrospective
cohort Setting: Tertiary referral center Participants: All patients
undergoing total laryngectomy at the [removed for blind peer review]
over the 10 year period January 2008 to December 2017. Main outcome
measures: Incidence of PCF; treatment of PCF (conservative versus
operative), closure success rate; time to closure; delay in adjuvant
radiotherapy; increased the need of future neopharyngeal dilatations;
overall survival. Results: A total of 242 patients (199 males, 43
females) were analysed. One hundred and fifteen patients underwent
primary laryngectomy, 102 salvage laryngectomy and 25 functional
laryngectomy. Seventy five of 242(31%) patients had a PCF. This was
managed conservatively in 36/75 (48%) and operatively in 39/75 (52%) .
Hospital length of stay was significantly longer in the PCF group (OR
2.38, p=<0.001). 5 year overall survival was 44% in the no
PCF versus 24% in the PCF group, OR 1.7, p=0.001. PCF was not
correlated with delay to adjuvant radiotherapy or the risk of
neopharyngeal dilatation. Conclusions: Despite efforts to identify risk
factors and take preventive measures, PCF remains an all to frequent
complication of total laryngectomy. PCF leads to increased morbidity and
significantly worse overall survival. The increased mortality is not a
result of a delay in adjuvant radiotherapy.