Predictors of fistula after laringectomy: a 10-year review

Abstract

Introduction: Total laryngectomy (TL) is a surgical procedure used to treat advanced laryngeal cancer. Although effective, it is associated with several postoperative complications, one of the most important being pharyngocutaneous fistula (PCF). The incidence of this complication varies from 8.7% to 27%, depending on factors such as surgical technique and patient characteristics. The development of PCF can prolong hospital stay, increase treatment costs and compromise patient recovery.

Objectives: The study aimed to identify the predictors associated with the development of PCF in patients undergoing TL, contributing to the implementation of more effective preventive and therapeutic strategies.

Material and Methods: A retrospective, analytical study was performed based on data from patients who underwent TL in a single hospital between 2013 and 2023. Pre-, peri- and post-operative factors were analysed, including age, smoking, alcohol consumption, nutritional status, surgical technique and post-operative laboratory parameters. Statistical analysis included univariate tests and binary logistic regression to identify independent risk factors.

Results: The sample included 66 patients with a mean age of 62.14 years. The incidence of PCF was significantly associated with oropharyngeal tumour involvement (OR = 23.1; p = 0.010). In univariate analysis, lower levels of albuminemia (p = 0.012), total proteinemia (p = 0.045) and haemoglobinemia (p = 0.023) were also associated with PCF, but did not remain significant in logistic regression. Other factors such as smoking, alcoholism, history of oncological treatment and closure technique were not statistically significant.

Conclusions: Pharyngeal tumour involvement was identified as the main independent risk factor for the development of PCF after TL. Nutritional and haematological factors showed an association in univariate analysis, but their impact seems to be secondary. Preoperative optimisation of nutritional status and selection of the most appropriate surgical technique may reduce complications and improve clinical outcomes.