Pharyngocutaneous fistula: a common complication following laryngectomy: JAMA

A recent multicenter retrospective cohort study conducted by a team of researchers from the Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada found that development of pharyngocutaneous fistula after salvage laryngectomy is associated with an increased risk for the development of distant metastases.

The study is published in the JAMA Otolaryngology- Head & Neck Surgery.

The objective of the study was to determine if pharyngocutaneous fistula after salvage laryngectomy is associated with locoregional and distant control, disease-free survival, and/or overall survival.

A total of 550 patients who underwent salvage laryngectomy for recurrent laryngeal cancer were included in the study. The median follow-up time was 5.7 years (range, 0-18 years).

The results revealed that all the 550 patients (mean [SD] age, 64 [10.4] years; men, 465 [85%]) met inclusion criteria. Out of the entire sample, pharyngocutaneous fistula occurred in 127 patients (23%).

The difference in locoregional control between the group of patients with pharyngocutaneous fistula (75%) and the non– pharyngocutaneous fistula (72%) group was 3% (95% CI, −6% to 12%).

The difference in overall survival between the group with pharyngocutaneous fistula (44%) and the non– pharyngocutaneous fistula group (52%) was 8% (95% CI, −2% to 20%). The difference in disease-free survival between pharyngocutaneous fistula and non– pharyngocutaneous fistula groups was 6% (95% CI, −4% to 16%).

Furthermore, in the multivariable model, patients with pharyngocutaneous fistula were at a 2-fold higher rate of distant metastases (hazard ratio, 2.00; 95% CI, 1.22 to 3.27). Distant control was reduced in those with pharyngocutaneous fistula, a 13% (95% CI, 3% to 21%) difference in 5-year distant control.

As a result, the authors concluded that development of pharyngocutaneous fistula after salvage laryngectomy is associated with an increased risk for the development of distant metastases.

doi:10.1001/jamaoto.2021.1545