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Pharyngocutaneous fistula after salvage laryngectomy: Impact of interval between radiotherapy and surgery, and performance of bilateral neck dissection
Author(s) -
Basheeth Naveed,
O'Leary Gerard,
Sheahan Patrick
Publication year - 2014
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.23337
Subject(s) - laryngectomy , medicine , surgery , neck dissection , fistula , radiation therapy , hypopharyngeal cancer , concomitant , complication , salvage surgery , larynx , cancer
Background Pharyngocutaneous fistula is a serious complication of total laryngectomy. The purpose of this study was to examine predisposing factors at our institution. Methods We conducted a retrospective review of 94 consecutive patients undergoing total laryngectomy. Cases with hypopharyngeal primary tumors or undergoing extended hypopharyngeal resection with flap augmentation of the pharynx were excluded. Results Seventy‐four cases met inclusion criteria. A total of 25.7% patients developed a pharyngocutaneous fistula. The fistula rate was higher after salvage laryngectomy than after primary surgery (34.0% vs 11.1%; p = .05). Among salvage laryngectomies, performance of laryngectomy within 1 year of completion of radiotherapy ( p = .006) and performance of concomitant bilateral neck dissection ( p = .02) were significant risk factors for development of a fistula. Radiation dose, addition of chemotherapy, use of pectoralis major myofascial flap, preoperative tracheostomy, primary puncture, primary tumor subsite, and initial T classification were not significant. Conclusion Interval between completion of radiotherapy and surgery is significantly associated with pharyngocutaneous fistula after salvage total laryngectomy. © 2013 Wiley Periodicals, Inc. Head Neck 36 : 580–584, 2014