European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026
Pharyngocutaneous fistula following total laryngectomy: a systematic review of risk factors and management strategies (2010-2024).
СтатьяСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Gomis-Lleal Elisabet, Sampieri Claudio, Costa-González José-Miguel, Vilaseca-González Isabel, Avilés-Jurado Francisco-Xavier, Bernal-Sprekelsen Manuel
Аннотация
IMPORTANCE: Pharyngocutaneous fistula (PCF) is the most common and morbid complication after total laryngectomy (TL).
OBJECTIVE: To systematically identify predictive factors and effective interventions for PCF.
DATA SOURCES: PubMed search of English-language studies published between 2010 and 2024.
STUDY SELECTION: Twenty-one observational cohort studies involving ≥25 adult patients undergoing TL and reporting PCF outcomes.
DATA SYNTHESIS: Narrative synthesis and descriptive analysis were performed due to heterogeneity in study design and outcome measures. Risk of bias was assessed using the ROBINS-I tool, and the certainty of evidence for each risk factor was rated according to GRADE methodology.
FINDINGS: Prior radiotherapy (OR 1.6-4.2), hypoalbuminemia, preoperative tracheostomy, and surgical closure without flap reinforcement were major risk factors for PCF. Conservative management succeeded in ~70% of cases. Flap reconstruction had higher success rates (~90%). Evidence certainty ranged from high (e.g., prior radiotherapy, hypoalbuminemia) to very low (e.g., antibiotic protocols), as summarized in a GRADE-based synthesis.
CONCLUSIONS AND RELEVANCE: Risk stratification, preoperative optimization, and surgical techniques such as flap reinforcement reduce PCF risk and improve postoperative outcomes.
OBJECTIVE: To systematically identify predictive factors and effective interventions for PCF.
DATA SOURCES: PubMed search of English-language studies published between 2010 and 2024.
STUDY SELECTION: Twenty-one observational cohort studies involving ≥25 adult patients undergoing TL and reporting PCF outcomes.
DATA SYNTHESIS: Narrative synthesis and descriptive analysis were performed due to heterogeneity in study design and outcome measures. Risk of bias was assessed using the ROBINS-I tool, and the certainty of evidence for each risk factor was rated according to GRADE methodology.
FINDINGS: Prior radiotherapy (OR 1.6-4.2), hypoalbuminemia, preoperative tracheostomy, and surgical closure without flap reinforcement were major risk factors for PCF. Conservative management succeeded in ~70% of cases. Flap reconstruction had higher success rates (~90%). Evidence certainty ranged from high (e.g., prior radiotherapy, hypoalbuminemia) to very low (e.g., antibiotic protocols), as summarized in a GRADE-based synthesis.
CONCLUSIONS AND RELEVANCE: Risk stratification, preoperative optimization, and surgical techniques such as flap reinforcement reduce PCF risk and improve postoperative outcomes.