Comparison of pharyngocutaneous fistula between patients followed by primary laryngopharyngectomy and salvage laryngopharyngectomy for advanced hypopharyngeal cancer

Background We analyzed the incidence rate, possible etiology, and management of pharyngocutaneous fistula after laryngopharyngectomy between hypopharyngeal cancer patients who received surgery first and subsequently concurrent chemoradiation therapy (CCRT) and those who received CCRT first followed by surgical salvage. Methods This is a case cohort, retrospective study collected in a tertiary medical center from January 1996 to July 2007. Results From the total of 160 patients, 52 patients (32.5%) developed pharyngocutaneous fistula. There is a significant difference between the pharyngocutaneous fistula rate of those with initial CCRT and the initial surgery groups. By univariate analysis and multiple logistic regression, tests revealed that preoperative radiation and hypo-albuminemia are risk factors for pharyngocutaneous fistula. A prolonged hospital course was noted among patients in the fistula group, especially when they received surgical repair, had hypo-albuminemia (albumin, <2.5 g/dL), or received preoperative radiation therapy (pre-OPRT). Conclusions Preoperative radiation therapy and hypo-albuminemia increase the fistula rate significantly. A prolonged hospital course was noted among all fistula patients.