Prophylactic endoluminal vacuum therapy after total laryngectomy or laryngopharyngectomy: a retrospective propensity score-matched cohort study.

OBJECTIVE

To evaluate the impact of prophylactic endoluminal vacuum-assisted closure (EndoVAC) on pharyngocutaneous fistula (PCF) incidence and duration of hospitalization following total laryngectomy (TL) or laryngopharyngectomy (LP).

METHODS

This retrospective cohort study included patients who underwent TL or LP at a single tertiary center between May 2006 and August 2025. PCF was defined based on clinical evidence of salivary leakage and/or radiologic confirmation using contrast-enhanced computed tomography or pharyngoesophagography. Multivariable logistic regression and 1:1 nearest-neighbor propensity score matching (PSM) were performed using age, defect size, flap type, and preoperative radiotherapy as covariates. Duration of hospitalization was analyzed using multivariable linear regression.

RESULTS

Among 114 patients, PCF occurred in 38 patients (33.3%). Prophylactic EndoVAC use was not significantly associated with PCF incidence in multivariable analysis (adjusted OR, 0.50, 95% CI, 0.12-2.05; p = 0.336). In the propensity score-matched cohort (n = 34), PCF occurred in 47.1% of the EndoVAC group and 29.4% of controls (OR, 2.13, 95% CI, 0.52-8.76; p = 0.481). However, prophylactic EndoVAC use was independently associated with a significantly shorter duration of hospitalization (β = -25.8 days, 95% CI, -41.7 to -9.9; p = 0.002).

CONCLUSION

Prophylactic EndoVAC was not associated with reduced PCF incidence after TL or LP. Although EndoVAC use was associated with shorter hospitalization, this finding should be considered exploratory and hypothesis-generating because of potential residual confounding and selection bias.