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Risk Factors for Pharyngocutaneous Fistula After Total Pharyngolaryngectomy

Lemaire, Emilien and Schultz, Philippe and Vergez, Sébastien and Debry, Christian and Sarini, Jérome and Vairel, Benjamin and de Bonnecaze, Guillaume and Takeda-Raguin, Catherine and Cabarrou, Bastien and Dupret Bories, Agnès Risk Factors for Pharyngocutaneous Fistula After Total Pharyngolaryngectomy. (2020) Ear, Nose & Throat Journal, 1 (7). 014556131990103. ISSN 0145-5613

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Official URL: https://doi.org/10.1177/0145561319901035


Purpose:To evaluate the risk factors of pharyngocutaneous fistula after total pharyngolaryngectomy (TPL) in orderto reduce theirincidence and propose a perioperative rehabilitation protocol.Materials and Methods:This was a multicenter retrospectivestudy 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 weredivided into a learning population and a validation population with patients who underwent surgery between 2006 and 2013 andbetween 2014 and 2016, respectively. A risk score of occurrence of salivary fistula was developed from the learning population dataand then applied on the validation population (temporal validation).Objective:To use a preoperative risk score in order tomodify 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, ahistory of cervical radiotherapy, mucosal closure in separate stitches instead of running sutures, and the placement of a pedicleflap instead of a free flap led to a maximum risk of post-op pharyngocutaneous fistula after TPL. The risk score was discriminantwith an area under the receiver operating characteristic curve of 0.66 (95% confidence interval [CI]¼0.59-0.73) and 0.70 (95% CI¼0.60-0.81) for the learning population and the validation population, respectively.Conclusion:A preoperative risk score couldbe used to reduce the rate of pharyngocutaneous fistula after TPL by removing 1 or more of the 4 identified risk factors.

Item Type:Article
Additional Information:Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License
HAL Id:hal-03203360
Audience (journal):International peer-reviewed journal
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Institution:Other partners > Centre Hospitalier Universitaire de Strasbourg - CHU Strasbourg (FRANCE)
Other partners > Institut Claudius Regaud - ICR (FRANCE)
Other partners > Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE)
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Deposited On:20 Apr 2021 15:36

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