Our Summary

This research paper looked at the risk factors of developing a condition called pharyngocutaneous fistula (PCF) after a surgery called total laryngectomy, which is the complete removal of the voice box. This condition is a complication that can occur after the surgery, where an abnormal connection forms between the throat and the skin.

To understand what increases the risk of developing this condition, the researchers combed through 52 studies involving 8605 patients who underwent the surgery. They found that 21% of these patients developed PCF.

The research found several factors that increased the risk of developing PCF. These included age, smoking, having chronic obstructive pulmonary disease (a type of lung disease), having coronary atherosclerotic heart disease (a type of heart disease), the stage of the tumor at the time of surgery, having had radiotherapy before the surgery, the levels of albumin and hemoglobin (proteins found in blood) before the surgery, the location of the tumor, and the method of treatment used.

In simpler terms, the older you are and if you smoke, have certain types of lung or heart disease, have had radiation therapy, have certain protein levels in your blood, or depending on where your tumor is located or how it’s treated, you could be at higher risk of developing this complication after voice box removal surgery.

FAQs

  1. What are the risk factors associated with pharyngocutaneous fistula (PCF) after total laryngectomy?
  2. How significant is the risk of developing PCF post-laryngectomy in patients who have had previous radiotherapy?
  3. How does age and pre-existing conditions like COPD and CAD contribute to the risk of developing PCF after a total laryngectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laryngectomy is to quit smoking and maintain good overall health, as smoking, chronic obstructive pulmonary disease (COPD), coronary atherosclerotic heart disease (CAD), and low levels of preoperative albumin and hemoglobin are risk factors for developing pharyngocutaneous fistula after total laryngectomy. It is also important to discuss previous radiotherapy, tumor site, and treatment method with your healthcare provider to minimize the risk of complications.

Suitable For

Patients who are typically recommended for laryngectomy are those with laryngeal cancer who have failed other treatment options such as radiation therapy or chemotherapy. Additionally, patients with advanced stage laryngeal cancer, those who have a history of smoking, chronic obstructive pulmonary disease (COPD), coronary atherosclerotic heart disease (CAD), and those who have undergone previous radiotherapy may also be recommended for laryngectomy. Other risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy include older age, low preoperative albumin levels, low preoperative hemoglobin levels, tumor site, and treatment method.

Timeline

Before laryngectomy:

  • Patient is diagnosed with laryngeal cancer
  • Patient undergoes preoperative evaluation and counseling
  • Patient may receive radiation therapy or chemotherapy
  • Patient undergoes total laryngectomy surgery

After laryngectomy:

  • Patient is monitored closely for complications such as pharyngocutaneous fistula (PCF)
  • Risk factors for PCF include age, smoking, COPD, CAD, T-stage, previous radiotherapy, preoperative albumin, preoperative hemoglobin, tumor site, and treatment method
  • Patient may require postoperative care and rehabilitation, including speech therapy and swallowing therapy
  • Patient may need to adjust to changes in speech and swallowing function
  • Patient may need long-term follow-up care for monitoring and management of any complications or recurrence of cancer.

What to Ask Your Doctor

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

  1. What is a pharyngocutaneous fistula (PCF) and how common is it after total laryngectomy?
  2. What are the risk factors for developing a PCF after laryngectomy?
  3. How can I reduce my risk of developing a PCF?
  4. How will my age, smoking history, COPD, CAD, T-stage, previous radiotherapy, preoperative albumin, preoperative hemoglobin, tumor site, and treatment method affect my risk of developing a PCF?
  5. What steps will be taken during surgery to minimize the risk of developing a PCF?
  6. How will a PCF be treated if it does occur after laryngectomy?
  7. What follow-up care will be necessary after laryngectomy to monitor for and prevent complications like PCF?
  8. Are there any lifestyle changes or precautions I should take to reduce my risk of developing a PCF after laryngectomy?
  9. What symptoms should I watch out for that may indicate the development of a PCF?
  10. How can I best communicate any concerns or questions I have about PCF with my healthcare team?

Reference

Authors: Wang M, Xun Y, Wang K, Lu L, Yu A, Guan B, Yu C. Journal: Eur Arch Otorhinolaryngol. 2020 Feb;277(2):585-599. doi: 10.1007/s00405-019-05718-9. Epub 2019 Nov 11. PMID: 31712878