Temporal Variability in the Incidence and Risk Factors for Pharyngocutaneous Fistula Development after Total Laryngectomy

Abstract

Background: This study aimed to analyse the variability in the incidence of the pharyngocutaneous fistula (PCF), the most common complication following a total laryngectomy (TLE), and to identify the underlying causes for fluctuations in incidence rates. Methods: In the retrospective study, the annual PCF incidence data and comprehensive clinicopathologic data from 540 patients who underwent TLE between January 2004 and December 2022 were reviewed. Distinct peri ods of both high and low PCF incidence were identified. Within these periods, patients were categorized into groups with PCF (study groups) and without it (control groups). These groups were statistically compared based on potential risk factors for PCF development. The high-incidence periods were specially analysed for recurring risk factors and the corresponding corrective measures were reviewed. Results: The analysis revealed four high-incidence periods with an overall PCF incidence of 37.61%, along with three low-incidence periods in between with an overall incidence of 19.38%. Surgical wound infection (SWI) and a history of head and neck cancer alongside their related treatments were repeatedly identified as independent risk factors during high-incidence periods, with SWI being the most consistent predictor of PCF development. Conclusions: Continuous monitoring of PCF incidence is crucial, as it allows for the identification of emerging risk factors and the immediate implementation of corrective measures to mitigate these newly identified risk factors.