Evaluation of Post Laryngectomy Pharyngocutaneous Fistula risk Factors

Document Type : Original

Authors

1 Department of Otorhinolaryngology-Head and Neck Surgery, Specialities Hospital, Faculty of Medicine in Rabat; Mohammed V University; Rabat. Morocco.

2 Department of Medical Emergency Care Unit, Ibn Sina Hospital. Faculty of Medicine in Rabat; Mohammed V University; Rabat. Morocco.

Abstract

Introduction:
Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy. Its incidence is extremely variable, with values ranging from 3% and 65%. The management of this problem considerably increases the length and the cost of hospitalization.  The aim of this study is to analyze the incidence, predisposing factors, and outcome of PCF in patients undergoing total laryngectomy in a Moroccan teaching hospital in Rabat, Morocco.
 Materials and Methods:
This study is a retrospective study including 136 patients who underwent total laryngectomy for squamous cell carcinoma of the larynx in our institution, between January 2006 and December 2013. Socio-demographical, biological, surgical, and outcome data were included.  Risk factors were analyzed for association with PCF formation.
 Results:
The overall PCF rate was 27.8%. The mean age was 58 (32-82 years). Univariate analysis showed age (P= 0,028), hemoglobin (P=0,026), and previous tracheotomy (P=0,028) to be associated with the onset of PCF. However, multivariate analysis revealed that previous tracheotomy (P=0,028) and low level of preoperative hemoglobin (P=0,026) were highly associated with the occurrence of PCF.
 Conclusion: 
This is an original work performed in an African country with a large serie. Our findings suggest that age, previous tracheotomy, and low level of haemoglobin are risk factors for PCF onset after total laryngectomy in T4 squamous cell carcinoma.

Keywords

Main Subjects

References

1. Rosenthal Di, Mohamed As, Weber Rs, Garden As, Sevak Pr, Kies Ms, et al. Long-term outcomes after surgical or nonsurgical initial therapy for patients with T4 squamous cell carcinoma of the larynx: A 3-decade survey. Cancer 2015; 121(10):1608-19

2. SATO.T. Treatment of laryngeal cancer Gan No Rinsho 1985; 31(12):1581-9.
3. Mäkitie Aa, Niemensivu R, Hero M,  Keski-Säntti H, Bäck L, Kajanti M, et al. Pharyngocutaneous fistula following total laryngectomy: a single institution's 10-year experience. Eur Arch Otorhinolaryngol 2006; 263 (12): 1127-30.
4. Palomar-Asenjo V, Sarroca Capell E, Tobías Gómez S, Pérez Hernández I, Palomar-García V. Pharyngocutaneous Fistula Following Total Laryngectomy. A Case-Control Study of Risk : Factors Implicated in its Onset. Acta Otorrinolaringol Esp 2008;59(10):480-4.
5. Cecattoa Sb, Monteiro Soaresa M, Henriquesa T,  Monteirob E, Ferreira Pinto Mourac CI.  Predictive factors for the postlaryngectomy pharyngocutaneous fistula development: systematic review. Braz J Otorhinolaryngol 2014;80(2):167-77.
6.  Paydarfar Ja, Birkmeyer NJ. Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg 2006; 132: 67-72.
7. Cavalot Andrea L, Gervasio Cf, Nazionale G, Albera R, Bussi M, Staffieri A, et al. Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records Otolaryngol Head Neck Surg 2000;123(5):587-92.
8. Saki N, Nikakhlagh S, Kazemi M. Pharyngocutaneous Fistula after Laryngectomy: Incidence,Predisposing Factors, and Outcome. Arch Iranian Med 2008; 11 (3): 314 – 317
9. Zhang X, Liu Z, Li Q, Liu X, Li H, Liu W, et al. Using a linear stapler for pharyngeal closure in total laryngectomy Eur Arch Otorhinolaryngol 2013; 270:1467–71.
10. Benson Em, Hirata Rm, Thompson Cb,  Ha Pk, Fakhry C, Saunders Jr,  et al. Pharyngocutaneous fistula after total laryngectomy: A single-institution experience, 2001-2012. Am J Otolaryngol2015;36 (1):24-31.
11. World Health Organization: Country Cooperation Strategy for WHO and Morocco 2004-2007. (Http:// Www. Who. Int/ Countries/ En/ Cooperation_ Strategy_Mar_En.Pdf ) Accessed 24 September 2010.
12. Timmermans Aj, Lansaat L, Theunissen Ea, Hamming-Vrieze  O, Hilgers Fj, Van Den Brekel Mw. Predictive factors for pharyngocutaneous fistulization after  total laryngectomy. Ann Otol Rhinol Laryngol 2014;123(3):153-61.
13. Dedivitis Ra, Ribeiro Kc, Castro Ma, Nascimento Pc. Pharyngocutaneous fistula following total laryngectomy. Acta Otorhinolaryngol Ital 2007;     27:2-5.
14. Markou Kd, Vlachtsis Kc, Nikolaou Ac, Petridis Dg, Kouloulas Ai, Daniilidis Ic. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence? Eur Arch Otorhinolaryngol 2004;261:61-7.
15. Gonzalez Aguilar O, Pardo Ha, Vannelli A, Simkin Do, Rossi A, Rubino A, et al. Total laryngectomy: pre- and intrasurgical variables of infection risk. Int Surg 2001;86:42-8.
16. R. Schwartz S, Yueh B, Maynard C,  Daley J,   Henderson W, F. Khuri S. Predictors of wound complications after laryngectomy: A study of over 2000 patients. Otolaryngology - Head and Neck Surgery 2004;131(1): 61–8.
17. Esteban F, Delgado-Rodríguez M, Mochón A, Solano J, Soldado L, Solanellas J. Study of in-patient hospital stay following totallaryngectomy: multivariable retrospective analysis of a 442 total laryngectomies. Acta Otorrinolaringológica Española 2006; 57(4): 176–82.
18. Betlejewski S, Szymańska-Skrzypek. Post-Laryngectomy Pharyngocutaneous Fistula-A Continuing Clinical Problem. A Otolaryngol Pol 2007; 61(3):271-9.
19. Scotton W, Cobb R, Pang L, Nixon I, Joshi A, Jeannon Jp, et al. Post-operative wound infection in salvage laryngectomy: does antibiotic prophylaxis have an impact? Eur Arch Otorhinolaryngol 2012; 269:2415–22.
Iranian Journal of Otorhinolaryngology
Volume 28, Issue 2 - Serial Number 2
March and April 2016
Pages 141-147

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