An Institutional Experience with the Development of Pharyngocutaneous Fistulas following Total Laryngectomy with Free Flaps

Abstract

Objectives:

Pharyngocutaneous fistulas (PCF) are common after salvage total laryngectomies (TL). Prior studies examining the role of fistula formation (FF) at the time of TL to reduce the incidence of PCF are conflicting. We studied our institutional experience, where in the last few years a more routine approach to using FFs with TLs has been adopted irrespective of the size of the mucosal defect resulting from the TL. It is hypothesized that this routine approach reduces the incidence of PCFs.

Methods:

This is a retrospective study reviewing the records of patients who had TLs with FF between 2007-2012. The date of surgery, site of recurrent disease, and whether the TL was primary or salvage were recorded. The primary outcome was the presence of PCF.

Results:

50 patients had a FF at the time of TL. Nine of these developed a PCF. The overall PCF incidence was 18%. The incidence following salvage TL was 22% (8/36), and that after primary TL was 7% (1/14). Between 2007-2009, the PCF incidence was 36% (7/19), while from 2010-2012 it was 3% (1/31).

Conclusions:

Our institutional experience with the use of FFs for TLs shows an overall PCF incidence comparable to rates reported in the literature. Over the last two years a statistically significant lower PCF incidence is seen (3% vs 36%), which reflects our gradual change in approach from a less to more routine use of FF. The routine use of FFs at the time of TLs reduces the incidence of PCF.