Post-Laryngectomy Stricture and Pharyngocutaneous Fistula: Review of Techniques in Primary Pharyngeal Reconstruction in Laryngectomy

Abstract

Objective

The purpose of this study is to find a correlation between closure technique in pharyngeal closure and outcomes of both pharyngocutaneous fistula and post-laryngectomy stricture after laryngectomy.

Study Design

Retrospective Chart Review.

Methods

We retrospectively reviewed a total of 151 patients over a 20 year period from January 1994 to December of 2013 who underwent primary pharyngeal reconstruction after total laryngectomy specifically looking at the closure technique in relation to pharyngo-cutaneous fistula (PCF) and post-laryngectomy stricture post-operatively. Patients were excluded based on secondary pharyngeal closure. Using logistic regression modeling, we performed univariate and multivariate analysis of our data.

Results

The overall PCF and post-laryngectomy stricture rates were 19.1% and 15.8%. When salvage laryngectomy was excluded, t-type closure had a significantly lower risk of fistula rate (p = 0.038) compared to vertical closure. In multivariate analysis, this statistical significance was lost (p = 0.23); however, non-salvage t-type closure remained significantly better than both salvage laryngectomy groups (t-type, p = 0.033, vertical, p = 0.037) while non-salvage vertical closure had no significant difference from other groups. There was no difference in stricture rate between the two closure techniques (p = 0.63)

Conclusion

Our study supports the role of t-type closure decreasing fistula rates in primary pharyngeal reconstruction. Orientation of the pharyngeal closure does not appear to change the risk of post-laryngectomy stricture formation after total laryngectomy. Salvage laryngectomy with primary pharyngeal reconstruction remains an independent risk factor for fistula formation.

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