PLoS One. 2026 Jun 2;21(6):e0348792. doi: 10.1371/journal.pone.0348792. eCollection 2026.
ABSTRACT
OBJECTIVE: To determine the prevalence and identify associated risk factors of pharyngocutaneous fistula following total laryngectomy.
METHODS: Medical records of 160 patients diagnosed with laryngeal cancer between 2000-2021, subsequently undergoing total laryngectomy at Karolinska University Hospital, were analyzed for demographics, comorbidities, tumor characteristics, treatments and postoperative outcomes. Uni- and multivariate analyses were used to identify risk factors for pharyngocutaneous fistula.
RESULTS: Pharyngocutaneous fistula developed in 28 patients (17.5%). Univariate analysis identified cardiovascular disease (OR 2.50; 95% CI 1.00-6.28), preoperative hemoglobin <110 g/L (OR 5.34; 95% CI 1.74-16.45), prior radiotherapy (OR 3.78; 95% CI 1.24-11.52), preoperative tracheostomy (OR 2.44; 95% CI 1.05-5.72), pharyngectomy (OR 8.47; 95% CI 2.46-29.17), neck dissection (OR 2.52; 95% CI 1.06-6.00), pectoral flap reconstruction (OR 10.83; 95% CI 1.88-62.49) and postoperative infection (OR 28.44; 95% CI 9.00-89.81) as significant risk factors. In multivariate analysis only pharyngectomy (OR 7.18; 95% CI 1.08-47.63; p = 0.041) and postoperative infection (OR 24.94; 95% CI 6.66-93.46; p < 0.001) remained independent.
CONCLUSIONS: Pharyngocutaneous fistula is a common complication occurring in 17.5% of patients following total laryngectomy. Pharyngectomy and postoperative infection are independent risk factors for fistula formation.
PMID:42228688 | DOI:10.1371/journal.pone.0348792