Factors predicting pharyngocutaneous fistula in patients after salvage laryngectomy for laryngeal malignancy – A multicenter collaborative cohort study

Conall W.R. Fitzgerald, Joel C. Davies, John R. de Almeida, Jason T. Rich, Mario Orsini, Antoine Eskander, Eric Monteiro, Ximena Mimica, Tim Mclean, Jennifer R. Cracchiolo, Ian Ganly, Amy Hessel, Samantha Tam, Dongmin Wei, Ryan Goepfert, Jie Su, Wei Xu, Mark Zafereo, David P. Goldstein, Marc A. Cohen

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Pharyngocutaneous fistula (PCF) is a major morbidity of salvage total laryngectomy (TL). Understanding the factors predicting PCF is fundamental to managing laryngeal cancer. We aim to assess factors associated with PCF following salvage TL in a multicenter, international retrospective cohort study of academic centers in the US and Canada. Results: In total, 550 patients post-salvage TL were identified (mean [SD; range] age, 64 [10.4; 32–90] years; 465 [85 %] male and 84 [15 %] female) between 2000 and 2014. Rate of PCF was 23 % (n = 127) with median time to PCF of 2.9 weeks. Surgical management of PCF was required in 43 % (n = 54) while 57 % (n = 73) required wound care alone. Rates of PCF differed by primary treatment modality [radiation, 20 % (n = 76); chemoradiation, 27 % (n = 40); not available (n = 6)] and use of vascularized tissue in pharyngeal closure [free/regional flap, 18 % (n = 25); no vascularized tissue/primary closure, 24 % (n = 98); not available (n = 4)]. There was no statistically significant association between PCF and treatment with chemoradiation (HR, 1.32; 95 % CI, 0.91–1.93, p = 0.14) or lack of vascularized tissue reconstruction (HR, 1.41, 95 % CI 0.91–2.18, p = 0.12). Significant association between PCF and advanced stage (T3 or T4), positive margin, close margin (<5mm), lymphovascular invasion and pre-operative tracheostomy were identified on univariable analysis. Positive surgical margin (HR, 1.91; 95 % CI, 1.11 to 3.29) was the only significant association on multivariable analysis. Conclusion: We highlight positive surgical margin as the only variable significantly associated with increased risk of PCF following salvage TL on multivariable analysis in a large cohort across several major head and neck oncology centers.

Original languageEnglish
Article number106089
JournalOral Oncology
Volume134
DOIs
StatePublished - Nov 2022

Keywords

  • Head and neck malignancy
  • Laryngeal squamous cell carcinoma
  • Laryngectomy
  • Pharyngocutaneous fistula
  • Surgery

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