Risk Factors for Pharyngocutaneous Fistula Formation: A Study Focused on Pharyngeal Reconstruction Technique

Barcan Y., Alimoglu Y., Gurbuz G., UYSAL Ö.

Journal of Laryngology and Otology, vol.139, no.2, pp.134-140, 2025 (SCI-Expanded, Scopus) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 139 Issue: 2
  • Publication Date: 2025
  • Doi Number: 10.1017/s0022215124001415
  • Journal Name: Journal of Laryngology and Otology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, CINAHL, MLA - Modern Language Association Database, Veterinary Science Database
  • Page Numbers: pp.134-140
  • Keywords: laryngectomy, larynx cancer, pharyngocutaneous fistula, suture techniques
  • Istanbul University-Cerrahpasa Affiliated: Yes

Abstract

Objective: This study investigated the risk factors for developing pharyngocutaneous fistula (PCF), the most common complication following total laryngectomy. Methods: We included all patients who underwent total laryngectomy and bilateral neck dissection from 2009 to 2021. Patients excluded were those with hypopharyngeal involvement, total or partial pharyngectomy, base of the tongue resection, large pharyngeal defects requiring free/pedicle flap reconstruction, or salvage laryngectomy. Results: A total of 164 patients participated in the study. Multivariate regression analysis identified two independent predictors of PCF formation: pharyngeal reconstruction with simple interrupted sutures (odds ratio[OR]:3.12, 95% confidence interval[CI] 1.31-17.00, p=0.010) and radical neck dissection (OR:3.16, 95%CI 1.13-8.82, p=0.028). Conclusions: Our findings suggest that pharyngeal reconstruction using simple interrupted sutures and radical neck dissection are independent risk factors for PCF development. Based on this, we recommend using the Modified Cushing suture technique over simple interrupted sutures due to its association with a significantly lower PCF rate.