Details

Autor(en) / Beteiligte

• Lemaire, Emilien
• Schultz, Philippe
• Vergez, Sébastien
• Debry, Christian
• Sarini, Jérome
• Vairel, Benjamin
• de Bonnecaze, Guillaume
• Takeda-Raguin, Catherine
• Cabarrou, Bastien
• Dupret-Bories, Agnès

Titel

Risk Factors for Pharyngocutaneous Fistula After Total Pharyngolaryngectomy

Ist Teil von

• Ear, nose, & throat journal, 2021-09, Vol.100 (5_suppl), p.746S-752S

Ort / Verlag

Los Angeles, CA: SAGE Publications

Erscheinungsjahr

2021

Quelle

MEDLINE

Beschreibungen/Notizen

• Purpose: To evaluate the risk factors of pharyngocutaneous fistula after total pharyngolaryngectomy (TPL) in order to reduce their incidence and propose a perioperative rehabilitation protocol. Materials and Methods: This was a multicenter retrospective study based on 456 patients operated for squamous cell carcinoma by total laryngectomy or TPL. Sociodemographic, medical, surgical, carcinologic, and biological risk factors were studied. Reactive C protein was evaluated on post-op day 5. Patients were divided into a learning population and a validation population with patients who underwent surgery between 2006 and 2013 and between 2014 and 2016, respectively. A risk score of occurrence of salivary fistula was developed from the learning population data and then applied on the validation population (temporal validation). Objective: To use a preoperative risk score in order to modify practices and reduce the incidence of pharyngocutaneous fistula. Results: Four hundred fifty-six patients were included, 328 in the learning population and 128 in the validation population. The combination of active smoking over 20 pack-years, a history of cervical radiotherapy, mucosal closure in separate stitches instead of running sutures, and the placement of a pedicle flap instead of a free flap led to a maximum risk of post-op pharyngocutaneous fistula after TPL. The risk score was discriminant with an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI] = 0.59-0.73) and 0.70 (95% CI = 0.60-0.81) for the learning population and the validation population, respectively. Conclusion: A preoperative risk score could be used to reduce the rate of pharyngocutaneous fistula after TPL by removing 1 or more of the 4 identified risk factors.