European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 1, pp 143–151 | Cite as

Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal

  • Maria CasasayasEmail author
  • Aina Sansa
  • Jacinto García-Lorenzo
  • Montserrat López
  • César Orús
  • Xavier Peláez
  • Miquel Quer
  • Xavier León



The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system.


This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality.


PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels < 99 g/L were associated with a significantly higher risk of developing major fistula.


We propose a new PCF classification system according to clinical severity. Predictors of major fistula were the type of surgery, previous radiotherapy, and low (< 99 g/L) postoperative hemoglobin levels. We consider the use of onlay flaps in irradiated patients who require partial pharyngectomy.


Total laryngectomy Pharyngectomy Pharyngocutaneous fistula Postoperative complications Cancer larynx 



This work was supported by grants from Plan Estatal de I + D + I of the Instituto de Salud Carlos III (FIS PI14/01819). Fondo Europeo de Desarrollo Regional (FEDER), A Way to Build Europe.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Research involving human participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional, regional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

405_2018_5200_MOESM1_ESM.doc (54 kb)
Supplementary material 1 (DOC 53 KB)
405_2018_5200_MOESM2_ESM.doc (57 kb)
Supplementary material 2 (DOC 57 KB)
405_2018_5200_MOESM3_ESM.doc (58 kb)
Supplementary material 3 (DOC 57 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Otorhinolaryngology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
  2. 2.Anesthesiology DepartmentHospital de la Santa Creu i Sant Pau, Universitat Autònoma de BarcelonaBarcelonaSpain
  3. 3.Centro de Investigación Biomédica en Red de BioingenieríaBiomateriales y Nanomedicina (CIBER-BBN)MadridSpain

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