Pharyngocutaneous fistula after total laryngectomy: emphasis on lymph node metastases as a new predisposing factor.

Objective: We investigated patient-related and local risk factors for pharyngocutaneous fistula developing after total laryngectomy.

Design: Retrospective clinical study.

Setting: Tertiary medical centre.

Method: The study included 255 patients who underwent total laryngectomy and concurrent neck dissection between July 2001 and February 2006 for laryngeal cancer.

Main Outcome Measures: The association of fistula and patient-related (age, sex, hemoglobin and albumin levels, diabetes mellitus, chronic obstructive pulmonary disease, chronic congestive heart disease, hypertension) and local risk factors (T stage of the tumour and localization, previous radiotherapy, preoperative tracheostomy, lymph node metastases, surgical margin) was analyzed using the chi-square and independent-sample t-tests.

Results: Pharyngocutaneous fistulae were found in 18.4% of the patients. Lymph node metastases, chronic congestive heart disease, and postoperative hemoglobin and albumin levels lower than 10.84 +/- 1.2 g/dL and 3.06 +/- 0.5 g/dL, respectively, were found to be statistically significant risk factors in fistula formation. The logistic regression model was carried out on these risk factors.

Conclusion: Pharyngocutaneous fistula remains the most frequent complication of total laryngectomy despite improved preoperative assessment and postoperative care. Lymph node metastases emerged for the first time as a risk factor for fistula formation. Our experience confirmed that meticulous postoperative care should be paid to the patients who have contributing risk factors and lymph node metastases.