Pharyngo‐cutaneous fistulae after laryngectomy. Influence of previous radiotherapy and prophylactic metronidazole

Abstract

The development of a pharyngocutaneous fistulae is a major complication after total laryngectomy. In Denmark radiotherapy is the primary treatment for all laryngeal carcinomas. Based on the experience with conventional daily irradiation, a split‐course radiation schedule was introduced in 1978. The charts of 106 consecutive patients laryngectomized for recurrence in the years 1975 to 1984 were examined. Thirty‐four patients developed a fistula. An evaluation of the different radiotherapy schedules used during this period allowed a dose‐response curve to be constructed. It showed a pronounced increase of fistulae with high doses of radiotherapy. Split‐course radiotherapy caused a rise in late complications and did not improve tumor control. Large field sizes increased the number of fistulae. High‐dose fractions showed a surprisingly high incidence of late complications. Prophylactic metronidazole (introduced in 1980) resulted in a highly significant decrease in the frequency of postoperative fistulae. Patients in whom fistula formed were hospitalized for an average of 54 days, patients without, for 22 days. Copyright © 1988 American Cancer Society