Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal
Purpose The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system. Methods This is a retrospective study of 400 patients who u...
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| Veröffentlicht in: | European archives of oto-rhino-laryngology 2019-01, Vol.276 (1), p.143-151 |
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| container_title | European archives of oto-rhino-laryngology |
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| creator | Casasayas, Maria Sansa, Aina García-Lorenzo, Jacinto López, Montserrat Orús, César Peláez, Xavier Quer, Miquel León, Xavier |
| description | Purpose
The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system.
Methods
This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality.
Results
PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels |
| doi_str_mv | 10.1007/s00405-018-5200-4 |
| format | Article |
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The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system.
Methods
This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality.
Results
PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels < 99 g/L were associated with a significantly higher risk of developing major fistula.
Conclusions
We propose a new PCF classification system according to clinical severity. Predictors of major fistula were the type of surgery, previous radiotherapy, and low (< 99 g/L) postoperative hemoglobin levels. We consider the use of onlay flaps in irradiated patients who require partial pharyngectomy.</description><identifier>ISSN: 0937-4477</identifier><identifier>EISSN: 1434-4726</identifier><identifier>DOI: 10.1007/s00405-018-5200-4</identifier><identifier>PMID: 30426230</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Cutaneous Fistula - classification ; Cutaneous Fistula - diagnosis ; Cutaneous Fistula - etiology ; Female ; Fistula - classification ; Fistula - diagnosis ; Fistula - etiology ; Head and Neck Surgery ; Humans ; Laryngeal Neoplasms - surgery ; Laryngectomy - adverse effects ; Laryngology ; Male ; Medicine ; Medicine & Public Health ; Multivariate Analysis ; Neurosurgery ; Otorhinolaryngology ; Pharyngeal Diseases - classification ; Pharyngeal Diseases - diagnosis ; Pharyngeal Diseases - etiology ; Pharyngectomy - adverse effects ; Postoperative Complications ; Retrospective Studies ; Risk Factors</subject><ispartof>European archives of oto-rhino-laryngology, 2019-01, Vol.276 (1), p.143-151</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c410t-bfc53013ac2bb535eef7e2b95705dfe14c7da225d546c3b4eb1abccda1d38efd3</citedby><cites>FETCH-LOGICAL-c410t-bfc53013ac2bb535eef7e2b95705dfe14c7da225d546c3b4eb1abccda1d38efd3</cites><orcidid>0000-0003-4183-5832</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00405-018-5200-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00405-018-5200-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30426230$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Casasayas, Maria</creatorcontrib><creatorcontrib>Sansa, Aina</creatorcontrib><creatorcontrib>García-Lorenzo, Jacinto</creatorcontrib><creatorcontrib>López, Montserrat</creatorcontrib><creatorcontrib>Orús, César</creatorcontrib><creatorcontrib>Peláez, Xavier</creatorcontrib><creatorcontrib>Quer, Miquel</creatorcontrib><creatorcontrib>León, Xavier</creatorcontrib><title>Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal</title><title>European archives of oto-rhino-laryngology</title><addtitle>Eur Arch Otorhinolaryngol</addtitle><addtitle>Eur Arch Otorhinolaryngol</addtitle><description>Purpose
The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system.
Methods
This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality.
Results
PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels < 99 g/L were associated with a significantly higher risk of developing major fistula.
Conclusions
We propose a new PCF classification system according to clinical severity. Predictors of major fistula were the type of surgery, previous radiotherapy, and low (< 99 g/L) postoperative hemoglobin levels. We consider the use of onlay flaps in irradiated patients who require partial pharyngectomy.</description><subject>Aged</subject><subject>Cutaneous Fistula - classification</subject><subject>Cutaneous Fistula - diagnosis</subject><subject>Cutaneous Fistula - etiology</subject><subject>Female</subject><subject>Fistula - classification</subject><subject>Fistula - diagnosis</subject><subject>Fistula - etiology</subject><subject>Head and Neck Surgery</subject><subject>Humans</subject><subject>Laryngeal Neoplasms - surgery</subject><subject>Laryngectomy - adverse effects</subject><subject>Laryngology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multivariate Analysis</subject><subject>Neurosurgery</subject><subject>Otorhinolaryngology</subject><subject>Pharyngeal Diseases - classification</subject><subject>Pharyngeal Diseases - diagnosis</subject><subject>Pharyngeal Diseases - etiology</subject><subject>Pharyngectomy - adverse effects</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><issn>0937-4477</issn><issn>1434-4726</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtuFDEQRS1ERIbAB7BBXrJpKL-mM-xQFB5SJLIIa6vstsHBPR5c7kjzA_luHDqwZFWLOveW6jD2SsBbATC-IwANZgBxPhgJMOgnbCO00oMe5fYp28BOjYPW43jKnhPdAoDRO_WMnSrQcisVbNj99Q-sx_334peG-1AW4jFRWzJyjC1U3krDzPMfKPhW5uN7Pi-5pTusCVvguMd8pES8RF4T_eQRO1apLyaOnMJdqKkdB4cUJu4zEqWYPLZU9vxQy6EQ5hfsJGKm8PJxnrFvHy9vLj4PV18_fbn4cDV4LaANLnqjQCj00jmjTAhxDNLtzAhmikFoP04opZmM3nrldHACnfcTikmdhzipM_Zm7e2Hfy2Bmp0T-ZDz-ruVQimtQRvZUbGivhaiGqI91DR3D1aAfdBvV_2267cP-q3umdeP9Yubw_Qv8dd3B-QKUF91odXelqV2g_Sf1t9g0ZU1</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Casasayas, Maria</creator><creator>Sansa, Aina</creator><creator>García-Lorenzo, Jacinto</creator><creator>López, Montserrat</creator><creator>Orús, César</creator><creator>Peláez, Xavier</creator><creator>Quer, Miquel</creator><creator>León, Xavier</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4183-5832</orcidid></search><sort><creationdate>20190101</creationdate><title>Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal</title><author>Casasayas, Maria ; Sansa, Aina ; García-Lorenzo, Jacinto ; López, Montserrat ; Orús, César ; Peláez, Xavier ; Quer, Miquel ; León, Xavier</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-bfc53013ac2bb535eef7e2b95705dfe14c7da225d546c3b4eb1abccda1d38efd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Cutaneous Fistula - classification</topic><topic>Cutaneous Fistula - diagnosis</topic><topic>Cutaneous Fistula - etiology</topic><topic>Female</topic><topic>Fistula - classification</topic><topic>Fistula - diagnosis</topic><topic>Fistula - etiology</topic><topic>Head and Neck Surgery</topic><topic>Humans</topic><topic>Laryngeal Neoplasms - surgery</topic><topic>Laryngectomy - adverse effects</topic><topic>Laryngology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multivariate Analysis</topic><topic>Neurosurgery</topic><topic>Otorhinolaryngology</topic><topic>Pharyngeal Diseases - classification</topic><topic>Pharyngeal Diseases - diagnosis</topic><topic>Pharyngeal Diseases - etiology</topic><topic>Pharyngectomy - adverse effects</topic><topic>Postoperative Complications</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Casasayas, Maria</creatorcontrib><creatorcontrib>Sansa, Aina</creatorcontrib><creatorcontrib>García-Lorenzo, Jacinto</creatorcontrib><creatorcontrib>López, Montserrat</creatorcontrib><creatorcontrib>Orús, César</creatorcontrib><creatorcontrib>Peláez, Xavier</creatorcontrib><creatorcontrib>Quer, Miquel</creatorcontrib><creatorcontrib>León, Xavier</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European archives of oto-rhino-laryngology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Casasayas, Maria</au><au>Sansa, Aina</au><au>García-Lorenzo, Jacinto</au><au>López, Montserrat</au><au>Orús, César</au><au>Peláez, Xavier</au><au>Quer, Miquel</au><au>León, Xavier</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal</atitle><jtitle>European archives of oto-rhino-laryngology</jtitle><stitle>Eur Arch Otorhinolaryngol</stitle><addtitle>Eur Arch Otorhinolaryngol</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>276</volume><issue>1</issue><spage>143</spage><epage>151</epage><pages>143-151</pages><issn>0937-4477</issn><eissn>1434-4726</eissn><abstract>Purpose
The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system.
Methods
This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality.
Results
PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels < 99 g/L were associated with a significantly higher risk of developing major fistula.
Conclusions
We propose a new PCF classification system according to clinical severity. Predictors of major fistula were the type of surgery, previous radiotherapy, and low (< 99 g/L) postoperative hemoglobin levels. We consider the use of onlay flaps in irradiated patients who require partial pharyngectomy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30426230</pmid><doi>10.1007/s00405-018-5200-4</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-4183-5832</orcidid></addata></record> |
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| subjects | Aged Cutaneous Fistula - classification Cutaneous Fistula - diagnosis Cutaneous Fistula - etiology Female Fistula - classification Fistula - diagnosis Fistula - etiology Head and Neck Surgery Humans Laryngeal Neoplasms - surgery Laryngectomy - adverse effects Laryngology Male Medicine Medicine & Public Health Multivariate Analysis Neurosurgery Otorhinolaryngology Pharyngeal Diseases - classification Pharyngeal Diseases - diagnosis Pharyngeal Diseases - etiology Pharyngectomy - adverse effects Postoperative Complications Retrospective Studies Risk Factors |
| title | Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal |
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