Temporal Variability in the Incidence and Risk Factors for Pharyngocutaneous Fistula Development after Total Laryngectomy

Simple Summary The pharyngocutaneous fistula (PCF) is a pathologic canal connecting the pharyngeal lumen with the skin of the neck occurring after a total laryngectomy (TLE), the removal of the entire larynx. The incidence of PCF ranges from 0% to 80%. Our study aimed to identify the temporal changes in PCF incidence over an extended period and determine the risk factors for increases in the PCF rate. By reviewing patient data from 2004 to 2022, we discovered a total incidence of 26.7%. This study revealed four high-incidence periods, averaging 37.61%, each followed by lower-incidence periods of 19.38%. The surgical wound infection and a history of head and neck cancer along with its related treatments were identified as independent risk factors during most of the high-incidence periods. The continuous monitoring of patients following TLE can assist providers in the better prediction and, consequently, timely management of PCF, ultimately improving patient outcomes after TLE.Abstract Background: This study aimed to analyse the variability in the incidence of the pharyngocutaneous fistula (PCF), the most common complication following a total laryngectomy (TLE), and to identify the underlying causes for fluctuations in incidence rates. Methods: In the retrospective study, the annual PCF incidence data and comprehensive clinicopathologic data from 540 patients who underwent TLE between January 2004 and December 2022 were reviewed. Distinct peri ods of both high and low PCF incidence were identified. Within these periods, patients were categorized into groups with PCF (study groups) and without it (control groups). These groups were statistically compared based on potential risk factors for PCF development. The high-incidence periods were specially analysed for recurring risk factors and the corresponding corrective measures were reviewed. Results: The analysis revealed four high-incidence periods with an overall PCF incidence of 37.61%, along with three low-incidence periods in between with an overall incidence of 19.38%. Surgical wound infection (SWI) and a history of head and neck cancer alongside their related treatments were repeatedly identified as independent risk factors during high-incidence periods, with SWI being the most consistent predictor of PCF development. Conclusions: Continuous monitoring of PCF incidence is crucial, as it allows for the identification of emerging risk factors and the immediate implementation of corrective measures to mitigate these newly identified risk factors.