[Pharyngocutaneous fistula as a complication after total laryngectomy--clinical study and literature review].

Unlabelled: Pharyngocutaneous fistula is an important therapeutic problem. It occurs in approximately 20% of cases as a complication after total laryngectomy, performed due to the larynx and/or hypopharynx cancer. The process of fistulas' conservative treatment is very long and sometimes reconstructive surgery of the pharynx and esophagus is necessary. Clinically, it is desirable to isolate a group of patients with risk factors of this complication. Numerous pathologies implicated in fistula formation are mentioned in the literature: wound infection, radiotherapy prior to surgery, hypoalbuminaemia, concomitant general diseases, postoperative anemia, location of the cancer in larynx and many others.

Objective: This paper analyzes the incidence and etiology of cutaneous fistulas after total laryngectomies as well as overall characterization of risk factors on the basis of the material collected by the Department of Otolaryngology Medical University of Warsaw between the years 2006-2011. Furthermore, an analysis of the literature on cutaneous fistula after total laryngectomy of the last 10 years was performed.

Material And Methods: A retrospective analysis of medical records of patients with laryngeal and hypopharyngeal cancer, treated with total laryngectomy was performed. 12 patients developed cutaneous fistula in the early postoperative period.

Results: The mean time of appearance of fistula after total laryngectomy was 19.3 days. In most cases, conservative management was used to obtain fistulas' closure - after an average of 32.5 days. For two patients operative closure was needed. Microbiological study confirmed the infection in the region of the fistula in 10 patients. There were identified different pathogens, both aerobic and anaerobic bacteria and fungi. 3 patients with a fistula were preoperatively irradiated. The most common location of the cancer in this group was supraglottic area and piriform recessus (8/12 patients).

Conclusions: The pathogenesis of cutaneous fistula as a complication after total laryngectomy seems to be complex. The most significant risk factors for fistula formation are: radiotherapy, supraglottic location of the tumor, extension of the surgery to the pharynx and malnutrition of the patient. Postoperative wound infection favors the formation of fistulas and extends their healing time. It seems reasonable to plan the surgery with the reconstruction of the pharynx for patients with several risk factors of fistulas' onset.