Title:
Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches
Authors:
C. Klç, Ü. Tuncel and E. Cömert
Institutions:
Department of Otorhinolaryngology, Ankara Oncology Training and Research Hospital, Ankara, Turkey
Keywords:
Cutaneous fistula; prealbumin; laryngectomy
Pages:
95 - 100
Abstract:
Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches. Objectives:To investigate the incidence and predisposing factors in the development of postoperative pharyngocutaneous fistula (PCF) after total laryngectomy. Methodology: A total of 166 patients with complete medical records who underwent total laryngectomy (TL) due to laryngeal cancer were analysed retrospectively. The mean age of the patients was 57.4 (+ 19.6) years. This study looked at a total of 32 different parameters considered to be effective in the development of pharyngocutaneous fistula after total laryngectomy. Results: Thirty-two patients (19.2%) had a pharyngocutaneous fistula. Aged over 61 years (p=0.003), Diabetes Mellitus (DM) (p=0.002), alcohol use (p=0.006), history of preoperative radiotherapy (p=0.001), preoperative tracheotomy (p=0.017), postoperative low levels of haemoglobin (Hb) (p=0.029), low levels of preoperative albumin (p=0.001), total protein and a low alb/glb (albumin/globulin) ratio (p=0.001), serum prealbumin levels on the third and seventh postoperative days (p=0.001), high postoperative CRP levels (p=0.002), T4 stage (extralaryngeal) and presence of transglottic lesion (p=0.003), presence of stage IV (p=0.012) lesion, primary surgery accompanied by bilateral neck dissection (p=0.047), T-shaped oesophagus suture, postoperative bleeding (p=0.07), presence of postoperative fever (p=0.001), presence of skin defect in the anterior neck (p=0.001) and presence of postoperative depression (p=0.001) were found to be statistically significant factors in the development of PCF. Conclusions: Our study found many parameters associated with an increased risk of the development of PCF. According tothemultivariateregressionanalysis,agedover61years,DM,preoperativeRT,preoperativetracheostomy,postoperative Hb under 10 g/dl, prealbumin under 17 mg/dl on the third postoperative day, and a postoperative fever of 38.3°C and above were found be associated with a higher risk of the development of fistulae more than the other risk factors.
Issue:
Vol. 11, 2015, 2nd trimester


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Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches