Prediction of pharyngocutaneous fistulas following laryngectomy utilizing clinical paramaters

Introduction:

Pharyngocutaneous fistulas following laryngectomy develop in approximately 20% of patients. Ample data on predisposing factors is available in the literature. It remains unclear though how fistula can be predicted in individual patients. Early fistula prediction would allow prompt barium pharyngography and operative revision. It is well known that early operative interventions reduce fistula recurrence.

Methods:

All patients who had undergone laryngectomy at this clinic were included into the study. CRP, leucocytes, body temperature and pain scale were obtained from all subjects. Patients were then stratified for known fistula risk factors. Youden's test was utilized for calculation of optimum cut-off values.

Results:

182 patients were included into the study. Pharyngocutaneous fistulas were diagnosed in 25% of the patients. CRP (p < 0,001) and leucocytes (p = 0,001) were significantly elevated in this patients group in comparison with non-fistula patients. Inflammatory markers failed to normalize in the postoperative course. All other parameters failed to show significant group differences. CRP-values exceeding > 4,4 mg/dl or leukocyte values > 5,9 G/l after the 5. postoperative day allowed fistula prediction with a sensitivitity of 0,974 and a negative predictive value of 0,976.

Conclusions:

CRP and leukocytes allow safe prediction of the development of postoperative pharyngocutaneous fistula.

Publication History

Publication Date:
18 April 2018 (online)