Prediction of pharyngocutaneous fistulas after laryngectomy

• Published in: Otolaryngology-head and neck surgery Vol. 136; no. 4; pp. s46 - s49
• Main Authors: Morton, Randall P., Mehanna, Hisham, Hall, Francis T., McIvor, Nicholas P.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Mosby, Inc 01-04-2007; SAGE Publications
• Subjects: Amylases - metabolism; Biomarkers - metabolism; Carcinoma, Squamous Cell - surgery; Cutaneous Fistula - diagnostic imaging; Cutaneous Fistula - enzymology; Cutaneous Fistula - etiology; Cutaneous Fistula - surgery; Female; Hemoglobins - metabolism; Hospitals, University; Humans; Laryngeal Neoplasms - surgery; Laryngectomy - adverse effects; Laryngectomy - methods; Male; Middle Aged; Neck Dissection; Pharyngeal Diseases - etiology; Pharyngeal Neoplasms - surgery; Pharyngectomy - adverse effects; Predictive Value of Tests; Prospective Studies; Radiography; Risk Assessment; Risk Factors; Sensitivity and Specificity; Serum Albumin - metabolism; Treatment Outcome
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1016/j.otohns.2006.11.030

To assess the predictive value of wound amylase as an indicator for pharyngocutaneous fistula development following laryngectomy for cancer.
We conducted a prospective observational study at a tertiary referral center of 102 consecutive laryngeal or hypopharyngeal cancer patients undergoing laryngectomy with or without pharyngectomy.
Data were collated on potential predictors of fistula formation compared with rate of development of clinical fistulas, all confirmed radiologically.
Rate of fistula formation was determined for the following potential predictors: extent of resection (extended laryngectomy), postoperative wound (drain) amylase, previous radiotherapy, neck dissection, preoperative and postoperative hemoglobin and albumin levels, and postoperative transfusion. Sensitivity, specificity, and positive and negative predictive values of significant predictors were ascertained.
The only significant predictors of fistula formation were extent of resection (extended laryngectomy) and drain amylase >4000 IU/L. If both factors are combined, the sensitivity, specificity, and positive and negative predictive values for fistula development are 83, 94, 63, and 98 percent, respectively.
We advocate that patients be managed postoperatively according to the presence or absence of these given predictors to reduce occurrence of fistula formation in the high-risk group.