Association Between Preoperative Albumin-to- Alkaline Phosphatase Ratio and Pharyngocutaneous Fistula After Total Laryngectomy

Objective: Pharyngocutaneous fistula (PCF) is an important complication after total laryngectomy, associated with delayed wound healing, prolonged hospitalization, and increased costs. Serum albumin reflects nutritional and immune status, whereas alkaline phosphatase reflects systemic inflammation and hepatic function. Albumin-to-alkaline phosphatase ratio (AAPR) may therefore represent a simple preoperative marker of nutritional and inflammatory status.

Methods: This retrospective cohort study included 82 patients who underwent primary total laryngectomy with simultaneous bilateral level II-IV neck dissection between 2016 and 2023. Preoperative serum albumin and alkaline phosphatase levels were recorded, and AAPR was calculated. Pharyngocutaneous fistula development was the primary outcome. The optimal AAPR cut-off associated with PCF was determined using receiver operating characteristic (ROC) analysis. Factors associated with PCF were analyzed using univariable and multivariable logistic regression.

Results: Pharyngocutaneous fistula occurred in 19 patients (23.1%). Preoperative AAPR was significantly lower in patients with PCF (P = .001). Receiver operating characteristic analysis demonstrated an area under the curve of 0.745. The exploratory AAPR cut-off value selected using the Youden index was 0.48, with 84% sensitivity and 60% specificity. Low AAPR was associated with PCF in univariable analysis (P < .05) but was not an independent predictor in multivariable analysis (P = .353). Advanced T stage remained independently associated with PCF (P = .048).

Conclusions: Preoperative AAPR was lower in patients who developed PCF and showed moderate discriminatory ability. However, AAPR did not remain an independent predictor after adjustment for T stage. Therefore, AAPR should be interpreted as an exploratory marker rather than a standalone predictor of PCF. Larger prospective studies are required.