Preoperative Anemia, Infections, and Salvage Surgery Linked to Higher Risk of Fistula After Laryngectomy: Study Finds
Tunisia: A recent retrospective study has highlighted the key risk factors associated with developing pharyngocutaneous fistula (PCF)-a common and serious postoperative complication—following total laryngectomy (TL). The findings, published in the Ear, Nose & Throat Journal, highlight preoperative anemia, wound infections, and salvage total laryngectomy (STL) as key factors that significantly increase the risk of pharyngocutaneous fistula (PCF) formation.
In the study conducted between 2007 and 2023, Rania Kharrat, Department of Otorhinolaryngology-Head and Neck Surgery, Habib Bourguiba Hospital, Sfax, Tunisia, and colleagues analyzed 132 patients who underwent either primary total laryngectomy (PTL) or STL as a treatment for advanced laryngeal cancer. Most patients (91%) underwent PTL, while the remaining 9% had STL. The incidence of PCF among the cohort was 13%, with cases emerging typically around two weeks post-surgery, although onset ranged from five to 36 days.
The study led to the following findings:
- Conservative management was effective in 76% of patients who developed pharyngocutaneous fistula (PCF).
- Surgical re-suturing was required in 24% of the affected cases.
- Statistical analysis revealed a strong association between specific clinical and procedural factors and the development of PCF.
- Univariate analysis identified preoperative anemia, salvage total laryngectomy (STL), wound infection, widened forward total laryngectomy, and hypoproteinemia as risk factors for PCF.
- Multivariate analysis confirmed preoperative anemia, wound infection, and STL as independent predictors of PCF.
- Patients with preoperative anemia had nearly seven times higher odds of developing PCF (OR = 6.9).
- The presence of wound infection increased the risk of PCF by approximately 6.5 times (OR = 6.5).
- STL was associated with the highest risk, with an odds ratio of 18.45 for developing PCF.
The authors emphasized that identifying and addressing these risk factors—especially anemia and infection before surgery—may significantly reduce the incidence of PCF and improve postoperative recovery. For patients requiring salvage procedures, preventive strategies such as using reconstructive flaps could play a crucial role in minimizing complications.
However, the study does acknowledge certain limitations. These include its retrospective nature, relatively small patient population, and variability in surgical technique due to multiple operating surgeons. Additionally, the study did not assess other potential contributors, such as nutritional markers, transfusion history, body mass index, and specific methods of pharyngeal closure.
In conclusion, the research underlines the importance of thorough preoperative evaluation and optimized postoperative care to reduce the risk of PCF. Addressing modifiable risk factors like anemia and infection and implementing targeted surgical approaches for high-risk patients could help enhance outcomes following total laryngectomy.
Reference:
Kharrat R, Sellami M, Ben Ayed M, et al. Risk Factors of Pharyngocutaneous Fistula Following Primary and Salvage Total Laryngectomy. Ear, Nose & Throat Journal. 2025;0(0). doi:10.1177/01455613251335526
