Subscribe to RSS
DOI: 10.5999/aps.2017.00906
Risk Factors of and Treatments for Pharyngocutaneous Fistula Occurring after Oropharynx and Hypopharynx Reconstruction
Background A pharyngocutaneous fistula is a common and difficult-to-manage complication after head and neck reconstruction. It can lead to serious complications such as flap failure, carotid artery rupture, and pharyngeal stricture, and may require additional surgery. Previous radiotherapy, a low serum albumin level, and a higher T stage have been proposed as contributing factors. We aimed to clarify the risk factors for pharyngocutaneous fistula in patients who underwent flap reconstruction and to describe our experiences in treating pharyngocutaneous fistula.
Methods Squamous cell carcinoma cases that underwent flap reconstruction after cancer resection from 1995 to 2013 were analyzed retrospectively. We investigated several significant clinical risk factors. The treatment modality was selected according to the size of the fistula and the state of the surrounding tissue, with options including conservative management, direct closure, flap surgery, and pharyngostoma formation.
Results A total of 127 cases (18 with fistulae) were analyzed. A higher T stage (P=0.048) and tube-type reconstruction (P=0.007) increased fistula incidence; other factors did not show statistical significance (P>0.05). Two cases were treated with conservative management, 1 case with direct closure, 4 cases with immediate reconstruction using a pectoralis major musculocutaneous flap, and 11 cases with direct closure (4 cases) or additional flap surgery (7 cases) after pharyngostoma formation.
Conclusions Pharyngocutaneous fistula requires global management from prevention to treatment. In cases of advanced-stage cancer and tube-type reconstruction, a more cautious approach should be employed. Once it occurs, an accurate diagnosis of the fistula and a thorough assessment of the surrounding tissue are necessary, and aggressive treatment should be implemented in order to ensure satisfactory long-term results.
This article was presented at the PRS KOREA 2016 on November 19, 2016 in Seoul, Korea.
Publication History
Received: 22 May 2017
Accepted: 26 September 2017
Article published online:
20 April 2022
© 2017. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
REFERENCES
- 1 Mattioli F, Bettini M, Molteni G. et al. Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status. Acta Otorhinolaryngol Ital 2015; 35: 243-8
- 2 Makitie AA, Irish J, Gullane PJ. Pharyngocutaneous fistula. Curr Opin Otolaryngol Head Neck Surg 2003; 11: 78-84
- 3 Boscolo-Rizzo P, De Cillis G, Marchiori C. et al. Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy. Eur Arch Otorhinolaryngol 2008; 265: 929-36
- 4 Leite AK, de Matos LL, Belli M. et al. Pectoralis major myocutaneous flap for head and neck reconstruction: risk factors for fistula formation. Acta Otorhinolaryngol Ital 2014; 34: 389-93
- 5 Dedivitis RA, Aires FT, Cernea CR. et al. Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors. Head Neck 2015; 37: 1691-7
- 6 Benson EM, Hirata RM, Thompson CB. et al. Pharyngocutaneous fistula after total laryngectomy: a single-institution experience, 2001–2012. Am J Otolaryngol 2015; 36: 24-31
- 7 Galli J, De Corso E, Volante M. et al. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Otolaryngol Head Neck Surg 2005; 133: 689-94
- 8 McCombe AW, Jones AS. Radiotherapy and complications of laryngectomy. J Laryngol Otol 1993; 107: 130-2
- 9 Dirven R, Swinson BD, Gao K. et al. The assessment of pharyngocutaneous fistula rate in patients treated primarily with definitive radiotherapy followed by salvage surgery of the larynx and hypopharynx. Laryngoscope 2009; 119: 1691-5
- 10 Aarts MC, Rovers MM, Grau C. et al. Salvage laryngectomy after primary radiotherapy: what are prognostic factors for the development of pharyngocutaneous fistulae?. Otolaryngol Head Neck Surg 2011; 144: 5-9
- 11 Soylu L, Kiroglu M, Aydogan B. et al. Pharyngocutaneous fistula following laryngectomy. Head Neck 1998; 20: 22-5
- 12 Markou KD, Vlachtsis KC, Nikolaou AC. et al. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?. Eur Arch Otorhinolaryngol 2004; 261: 61-7
- 13 Kao HK, Abdelrahman M, Chang KP. et al. Choice of flap affects fistula rate after salvage laryngopharyngectomy. Sci Rep 2015; 5: 9180
- 14 Chao JW, Spector JA, Taylor EM. et al. Pectoralis major myocutaneous flap versus free fasciocutaneous flap for reconstruction of partial hypopharyngeal defects: what should we be doing?. J Reconstr Microsurg 2015; 31: 198-204
- 15 Brookes GB. Nutritional status: a prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg 1985; 93: 69-74
- 16 Hamahata A, Beppu T, Saitou T. et al. The usefulness of triple layers suturing technique with frilled pectoralis major musculocutaneous flap for pharyngocutaneous fistula. J Plast Reconstr Aesthet Surg 2014; 67: e32-e33
- 17 Lopez F, Obeso S, Camporro D. et al. Outcomes following pharyngolaryngectomy with fasciocutaneous free flap reconstruction and salivary bypass tube. Laryngoscope 2013; 123: 591-6
- 18 Loaec E, Vaillant PY, Bonne L. et al. Negative-pressure wound therapy for the treatment of pharyngocutaneous fistula. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131: 351-5