In the study conducted between 2007 and 2023, Rania Kharrat, Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba Hospital, Sfax, Tunisia, and colleagues analyzed 132 patients who underwent either primary total laryngectomy (PTL) or STL as a treatment for advanced laryngeal cancer. Most patients (91%) underwent PTL, while the remaining 9% had STL. The incidence of PCF among the cohort was 13%, with cases emerging typically around two weeks post-surgery, although onset ranged from five to 36 days.
The study led to the following findings:
- Conservative management was effective in 76% of patients who developed pharyngocutaneous fistula (PCF).
- Surgical re-suturing was required in 24% of the affected cases.
- Statistical analysis revealed a strong association between specific clinical and procedural factors and the development of PCF.
- Univariate analysis identified preoperative anemia, salvage total laryngectomy (STL), wound infection, widened forward total laryngectomy, and hypoproteinemia as risk factors for PCF.
- Multivariate analysis confirmed preoperative anemia, wound infection, and STL as independent predictors of PCF.
- Patients with preoperative anemia had nearly seven times higher odds of developing PCF (OR = 6.9).
- The presence of wound infection increased the risk of PCF by approximately 6.5 times (OR = 6.5).
- STL was associated with the highest risk, with an odds ratio of 18.45 for developing PCF.
The authors emphasized that identifying and addressing these risk factors—especially anemia and infection before surgery—may significantly reduce the incidence of PCF and improve postoperative recovery. For patients requiring salvage procedures, preventive strategies such as using reconstructive flaps could play a crucial role in minimizing complications.
However, the study does acknowledge certain limitations. These include its retrospective nature, relatively small patient population, and variability in surgical technique due to multiple operating surgeons. Additionally, the study did not assess other potential contributors, such as nutritional markers, transfusion history, body mass index, and specific methods of pharyngeal closure.
In conclusion, the research underlines the importance of thorough preoperative evaluation and optimized postoperative care to reduce the risk of PCF. Addressing modifiable risk factors like anemia and infection and implementing targeted surgical approaches for high-risk patients could help enhance outcomes following total laryngectomy.
Reference:
Kharrat R, Sellami M, Ben Ayed M, et al. Risk Factors of Pharyngocutaneous Fistula Following Primary and Salvage Total Laryngectomy. Ear, Nose & Throat Journal. 2025;0(0). doi:10.1177/01455613251335526
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.