Complications in Head and Neck Surgery
Open Access
- 1 January 2006
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA Otolaryngology–Head & Neck Surgery
- Vol. 132 (1), 67-72
- https://doi.org/10.1001/archotol.132.1.67
Abstract
Objective To summarize the potential risk factors for postlaryngectomy pharyngocutaneous fistula. Data Sources Observational studies in the English-language literature about postlaryngectomy pharyngocutaneous fistula from January 1, 1970, to March 31, 2003. Studies were identified through a MEDLINE search with relevant key words; additional studies were identified through references. Study Selection We included studies about the site of primary malignancy, type of procedure, and type of closure; studies had to have been based on individual-level data, with a comparison group for each risk factor evaluated. Data Extraction Data required to calculate the relative risk of fistula associated with commonly reported risk factors were abstracted from the studies, and a meta-analysis using a random-effects approach was performed to estimate a summary relative risk of fistula for each risk factor. The statistical significance of heterogeneity of effects among studies was assessed. Data Synthesis Of 65 studies identified, 26 met the inclusion criteria. Significant risk factors identified in the pooled analysis included postoperative hemoglobin level less than 12.5 g/dL, prior tracheotomy, preoperative radiotherapy, and preoperative radiotherapy and concurrent neck dissection. The degree of heterogeneity of effects among studies was significant for postoperative hemoglobin level, preoperative radiotherapy, concurrent neck dissection, and comorbid illness. The severity of fistula was greater in patients with a history of radiotherapy. Conclusions This meta-analysis identified several significant risk factors for postlaryngectomy pharyngocutaneous fistula. The clinical implications of these findings and the potential sources of heterogeneity of effects among studies are discussed.Keywords
This publication has 30 references indexed in Scilit:
- Pharyngocutaneous Fistula as a Complication of Total Laryngectomy: Review of the Literature and Analysis of Case RecordsOtolaryngology -- Head and Neck Surgery, 2000
- Pharyngocutaneous fistula and total laryngectomy: possible predisposing factors, with emphasis on pharyngeal myotomyThe Journal of Laryngology & Otology, 2000
- Pharyngocutaneous fistula following laryngectomyHead & Neck, 1998
- Post-laryngectomy pharyngocutaneous fistula – a still unresolved problemThe Journal of Laryngology & Otology, 1995
- Use of the Nasogastric Tube after Total Laryngectomy: Is it Truly Necessary?Annals of Otology, Rhinology & Laryngology, 1990
- Pharyngo-cutaneous fistulae after laryngectomy.Influence of previous radiotherapy and prophylactic metronidazoleCancer, 1988
- Complications of Laryngectomy and Neck Dissection following Planned Preoperative RadiotherapyAnnals of Otology, Rhinology & Laryngology, 1977
- TESTS FOR HOMOGENEITY OF EFFECT IN AN EPIDEMIOLOGIC INVESTIGATION1American Journal of Epidemiology, 1977
- Complications following surgery for cancer of the larynx and hypopharynxCancer, 1977
- Pharyngo-cutaneous fistulae in totally laryngectomized patientsThe Journal of Laryngology & Otology, 1974