Pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis of risk factors

Objective: The pharyngocutaneous fistula (PCF) is the troublesome complication after total laryngectomy. Despite a large number of investigations having been performed, there is still controversy about which factors are most significant for PCF. The objective of the present meta-analysis was to analyze the potential risk factors for PCF after total laryngectomy. Data sources: Published English-language literature. Review methods: PubMed, Ovid, Cochrane, and Web of Science databases were systematically searched using multiple search terms. Twenty-one studies with 3832 patients were identified. The quality of evidence was assessed by The National Institute for Health and Clinical Excellence. Results: Sixteen studies involving 2598 patients were included for the meta-analysis. The results showed that, tumor subsite (RR = 0.64,95% CI 0.47-0.88, P < 0.01), T stage (RR = 0.70,95% CI 0.51-0.96, P = 0.03), previous radiotherapy (RR = 0.62, 95% CI 0.46-0.84, P < 0.01), postoperative hemoglobin <12.5 g/L (RR = 0.46, 95% CI 0.27-0.76, P < 0.01), and surgical margin (RR = 0.41, 95% CI 0.22-0.74, P < 0.01) were the risk factors associated with the development of PCF. Conclusions: From the results of our study, several significant risk factors for PCF are identified. Methodologically high-quality comparative studies are needed for further evaluation. (C) 2015 Elsevier Ireland Ltd. All rights reserved.