Postoperative Hypoproteinemia Highest Predictive Risk Factor for Pharyngocutaneous Fistula Following Total Laryngectomy

by Linda Kossoff •

What is the predictive value of various patient-, disease-, and surgery-related risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy?

BOTTOM LINE

Various factors, including postoperative hypoproteinemia, can influence PCF development after total laryngectomy.

BACKGROUND: PCF is a common complication after total laryngectomy. Associated with wound healing and delayed swallowing/vocal rehabilitation, PCF has a negative effect on patients’ quality of life. Several potential risk factors have been proposed as causes of PCF, but the diagnostic value of these factors has not been fully assessed.

STUDY DESIGN: Literature search and diagnostic meta-analysis.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

SYNOPSIS: Researchers conducted a literature search of six databases and collected characteristics of 58 studies in 9,845 patients for analysis. Inclusion criteria were patients undergoing laryngectomy, comparison of patients with PCF with a reference (patients without PCF), and data in a 2 X 2 table. The incidence of PCF in the included studies was 21.69%. The following factors were significantly associated with PCF occurrence: age, smoking, postoperative anemia and hypoproteinemia, diabetes mellitus, comorbidities, pulmonary disease, heart problems, tumor extension (only glottis versus more than glottis), previous radiation therapy, previous tracheostomy, surgery timing (salvage vs. primary), extended total laryngectomy (including pharyngectomy), and primary tracheoesophageal puncture. In predictive ability, postoperative hypoproteinemia showed the highest accuracy, possibly due to the involvement of the extent of surgery in hypoproteinemia and inflammation elicited by the trauma. The predictability of this factor, say authors, opens the possibility of enabling care strategies such as differentiated nutritional supplementation, close monitoring of the surgical site, or adjusted hospital stay. Authors note that these findings are consistent with previous reports. Study limitations included significantly heterogeneous data.

CITATION: Kim DH, Kim SW, Hwang SH. Predictive value of risk factors for pharyngocutaneous fistula after total laryngectomy. Laryngoscope. 2023;133:742-754.