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Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy

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Abstract

Pharyngocutaneous fistula is the leading complication following total laryngectomy. It delays complementary treatments, speech rehabilitation and oral feeding. Despite evolving medical care, fistula incidence remains high. There is no consensus regarding which patients are at higher risk for fistula development. This article comprised a literature review about risk factors for fistula development. All articles published on an on-line database (PUBMED™) using MESH terms “larynx cancer” and “fistula” in a 5-year period (January 1st, 2014 to January 27th, 2019) were included. Further articles were selected due to expert suggestion by one of the senior surgeons. Only articles written in Portuguese or English were included. Animal studies were excluded. 151 articles were selected and abstracts analysed. 82 articles were selected for full text revision. 32 were later excluded because they described single clinical cases, experimental surgical technics, irrelevant data or poor methodology. Final selection comprised 50 studies: 9 systematic reviews, one non-systematic review, 34 unicentric and 4 multicentric retrospective analysis and two prospective studies. There is no consensus regarding risk factors for fistula development. Patients submitted to salvage surgery for advanced disease seem to be at greater risk. Bad nutritional status is a logical contributor, but the ideal surrogate marker is still missing. Several variables are inconsistently pointed as risk factors and should be abandoned unless proved otherwise. There are no standard scores for fistula occurrence despite being a common complication following surgery.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Otorhinolaryngology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), Vila Nova de Gaia, Portugal

    José Ferreira Penêda

  2. Otorhinolaryngology Department, Instituto Português de Oncologia do Porto–Francisco Gentil (IPOP FG), Porto, Portugal

    João Fernandes & Eurico Monteiro

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  1. José Ferreira Penêda
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  2. João Fernandes
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  3. Eurico Monteiro
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Contributions

First author designed the study, collected data and drafted the article. Second and third authors reviewed the draft ans suggested additional references. First author re-wrote the draft till a consensus was reached. All authors approved the final version.

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Correspondence to José Ferreira Penêda.

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Penêda, J.F., Fernandes, J. & Monteiro, E. Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy. Indian J Otolaryngol Head Neck Surg 75, 485–491 (2023). https://doi.org/10.1007/s12070-022-03311-x

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  • DOI: https://doi.org/10.1007/s12070-022-03311-x

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