[Pharyngocutaneous fistula after total laryngectomy: incidence and analysis of risk factors].

Objectives: We evaluated the incidence and predisposing risk factors of pharyngocutaneous fistulas that develop after total laryngectomy.

Patients And Methods: The records of 210 patients (19 females, 191 males; mean age 60+/-9 years; range 39 to 77 years) who underwent total laryngectomy were retrospectively reviewed. Thirteen predisposing risk factors were evaluated (age, sex, pre-and postoperative anemia and hypoalbuminemia, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, hypertension, preoperative tracheotomy, tumor stage and localization).

Results: Pharyngocutaneous fistulas were found in 41 patients (19.5%). The mean duration for fistula formation was 7.7 days (range 2 to 16 days). Coronary artery disease (p=0.00), postoperative hemoglobin (p=0.000) and albumin (p<0.005) levels lower than 10.7+/-1.2 g/dl and 3.0+/-0.5 g/dl, respectively, were found to be significant risk factors for fistula formation.

Conclusion: Fistula formation is the most frequent complication in laryngectomy patients. To prevent fistula formation, special attention should be paid to surgical technique and postoperative care especially in patients who have coronary artery disease, anemia, and hypoalbuminemia.