Authors
Elisabet Gomis-Lleal, Claudio Sampieri, José-Miguel Costa-González, Isabel Vilaseca-González, Francisco-Xavier Avilés-Jurado, Manuel Bernal-Sprekelsen
Published in
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. Jun 22, 2026. Epub Jun 22, 2026.
Abstract
Pharyngocutaneous fistula (PCF) is the most common and morbid complication after total laryngectomy (TL).
To systematically identify predictive factors and effective interventions for PCF.
PubMed search of English-language studies published between 2010 and 2024.
Twenty-one observational cohort studies involving ≥25 adult patients undergoing TL and reporting PCF outcomes.
Narrative synthesis and descriptive analysis were performed due to heterogeneity in study design and outcome measures. Risk of bias was assessed using the ROBINS-I tool, and the certainty of evidence for each risk factor was rated according to GRADE methodology.
Prior radiotherapy (OR 1.6-4.2), hypoalbuminemia, preoperative tracheostomy, and surgical closure without flap reinforcement were major risk factors for PCF. Conservative management succeeded in ~70% of cases. Flap reconstruction had higher success rates (~90%). Evidence certainty ranged from high (e.g., prior radiotherapy, hypoalbuminemia) to very low (e.g., antibiotic protocols), as summarized in a GRADE-based synthesis.
Risk stratification, preoperative optimization, and surgical techniques such as flap reinforcement reduce PCF risk and improve postoperative outcomes.
PMID:
42324368
Bibliographic data and abstract were imported from PubMed on 22 Jun 2026.
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