Our Summary

This study aimed to understand the occurrence, risk factors, and management of pharyngocutaneous fistula (a complication where an abnormal connection forms between the throat and skin) after a type of throat surgery called total laryngectomy. The researchers looked at the medical records of 86 patients who developed this complication after surgery and compared them to 86 patients who did not.

They found that the overall occurrence of this complication was about 24.4%. The occurrence rates were 19.0%, 28.6% and 30.3% for three types of surgery: primary total laryngectomy, total laryngectomy after radiation therapy, and total laryngectomy after chemotherapy and radiation therapy, respectively.

The study also found that the risk of developing this complication was higher if the patient had low albumin levels (a type of protein in the blood), and if they had undergone radiation therapy or chemotherapy before surgery.

The management of this complication differed according to the type of surgery the patient had. For patients who had a primary total laryngectomy, conservative treatment (non-invasive management that doesn’t involve surgery) was enough in most cases. However, in cases where patients had undergone chemotherapy and radiation therapy before surgery, surgical closure with regional flaps was primarily used.

Understanding these risk factors and how to manage them can help surgeons plan better preventative strategies, reducing the occurrence of this complication, the length of hospital stays, and related costs.

FAQs

  1. What is the occurrence rate of pharyngocutaneous fistula after a total laryngectomy?
  2. What are some risk factors for developing a pharyngocutaneous fistula after a total laryngectomy?
  3. How is a pharyngocutaneous fistula managed after a total laryngectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laryngectomy is to ensure they maintain good nutrition before and after surgery to help prevent complications such as pharyngocutaneous fistula. This can include eating a balanced diet rich in protein, vitamins, and minerals, and possibly taking supplements if necessary. Additionally, quitting smoking and avoiding alcohol can also help reduce the risk of complications. Regular follow-up appointments with healthcare providers can also help monitor for any signs of potential issues and address them promptly.

Suitable For

Patients who are typically recommended laryngectomy are those with advanced laryngeal cancer that has not responded to other treatments such as radiation therapy or chemotherapy. Other reasons for recommending laryngectomy may include severe injury to the larynx, recurrent laryngeal papillomatosis, or other conditions affecting the larynx that cannot be treated effectively with other methods.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with a condition such as laryngeal cancer that requires surgery.
  2. Patient undergoes pre-operative consultations, tests, and preparations for surgery.
  3. Patient may undergo radiation therapy or chemotherapy before surgery, depending on the specific case.
  4. Patient undergoes total laryngectomy surgery to remove the larynx and surrounding tissues.

After laryngectomy:

  1. Patient may experience pain, swelling, and difficulty swallowing immediately after surgery.
  2. Patient receives post-operative care in the hospital, including monitoring for complications such as pharyngocutaneous fistula.
  3. Patient may undergo additional treatments such as speech therapy to learn how to communicate without a larynx.
  4. Patient may require a period of adjustment to living without a voice box, including using a stoma for breathing and speaking.
  5. Patient may experience long-term effects such as changes in voice quality, swallowing difficulties, and emotional challenges related to the surgery.
  6. Patient continues to receive follow-up care and monitoring for potential complications or recurrence of the underlying condition.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laryngectomy include:

  1. What is the likelihood of developing a pharyngocutaneous fistula after a total laryngectomy?
  2. Are there specific risk factors that increase my chances of developing this complication?
  3. Will my medical history, such as previous radiation therapy or chemotherapy, impact my risk of developing a pharyngocutaneous fistula?
  4. What steps can be taken before surgery to reduce the risk of developing this complication?
  5. What are the signs and symptoms of a pharyngocutaneous fistula that I should watch out for after surgery?
  6. How is a pharyngocutaneous fistula typically managed and treated if it does occur?
  7. Are there any lifestyle changes or precautions I should take post-surgery to prevent complications?
  8. How often will I need follow-up appointments to monitor for any potential issues related to the surgery?
  9. Are there any specific dietary restrictions or recommendations I should follow to aid in my recovery and prevent complications?
  10. What are the potential long-term effects or complications I should be aware of after a total laryngectomy?

Reference

Authors: Busoni M, Deganello A, Gallo O. Journal: Acta Otorhinolaryngol Ital. 2015 Dec;35(6):400-5. doi: 10.14639/0392-100X-626. PMID: 26900245