Dedivitis et al identified risk factors associated with pharyngocutaneous fistula following a total laryngectomy. The authors are from University of Sao Paula and Hospital Ana Costa in Brazil.
Patient selection: total laryngectomy for cancer
Risk factors for a pharyngocutaneous fistula:
(1) chronic obstructive pulmonary disease (COPD)
(2) "previous" hemoglobin < 12.5 g/dL (anemia; will use preoperative hemoglobin in the implementation)
(3) blood transfusion
(4) previous radiation therapy or chemoradiation
(5) advanced primary tumors (T3 or T4)
(6) supraglottic primary site
(7) hypopharyngeal involvement
(8) positive surgical margins
(9) neck dissection
The risk for a pharyngocutaneous fistula increases with the number and severity of the risk factors.
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