Predictive factors for the postlaryngectomy
               pharyngocutaneous fistula development: systematic review<sup>,</sup>

Cecatto, Suzana Boltes; Soares, Matilde Monteiro; Henriques, Teresa; Monteiro, Eurico; Moura, Carla Isabel Ferreira Pinto

doi:10.5935/1808-8694.20140034

Suzana Boltes Cecatto ^** Corresponding author. E-mail: suzanacecatto@yahoo.com.br / suboltes@hotmail.com (S.B. Cecatto).

Health Information and Decision Sciences Department (CIDES/CINTESIS), Faculdade de Medicina do Porto (CIM- FMUP), Porto, Portugal

Matilde Monteiro Soares

Health Information and Decision Sciences Department (CIDES/CINTESIS), Faculdade de Medicina do Porto (CIM- FMUP), Porto, Portugal

Teresa Henriques

Health Information and Decision Sciences Department (CIDES/CINTESIS), Faculdade de Medicina do Porto (CIM- FMUP), Porto, Portugal

Eurico Monteiro

Department of Otorhinolaryngology, Instituto Português de Oncologia do Porto (IPOPFG-EPE), Porto, Portugal

Carla Isabel Ferreira Pinto Moura

Department of Otorhinolaryngology, Hospital São João, Faculdade de Medicina do Porto, Universidade do Porto, Portugal

Figures (1)
Tables (3)

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Figure 1
- Flowchart of article selection.

The query used was: (postoperative complications[MeSH Terms]) OR postoperative complications[Title/Abstract]) OR postoperative complication[Title/Abstract]) OR postoperative complication[MeSH Terms]) OR complications, postoperative[MeSH Terms]) OR complications, postoperative[Title/Abstract]) OR complication, postoperative[Title/Abstract]) OR complication, postoperative[MeSH Terms]) OR surgical wound dehiscence[MeSH Terms]) OR surgical wound dehiscence[Title/Abstract]) OR dehiscence surgical wound[Title/Abstract]) OR dehiscence surgical wound[MeSH Terms]) OR anastomotic leaks[MeSH Terms]) OR anastomotic leaks[Title/Abstract]) OR anastomotic leakage[Title/Abstract]) OR anastomotic leakage[MeSH Terms]) OR anastomotic leakage[MeSH Terms]) OR anastomotic leakage[Title/Abstract]) OR healing wound[Title/Abstract]) OR healing wound[MeSH Terms]) OR fistula[MeSH Terms]) OR fistula[Title/Abstract]) OR pharyngocutaneous fistula[Title/Abstract]) OR pharyngocutaneous fistula[MeSH Terms]) OR cutaneous fistula[MeSH Terms]) OR cutaneous fistula[Title/Abstract]) OR skin fistula[Title/Abstract]) OR skin fistula[MeSH Terms]) OR external fistula[MeSH Terms]) OR external fistula[Title/Abstract]) OR salivary gland fistula[Title/Abstract]) OR salivary gland fistula[MeSH Terms]) OR pharyngostoma[MeSH Terms]) OR pharyngostoma[Title/Abstract]) OR postla ryngectomy pharyngocutaneous fistula[Title/Abstract]) OR postlaryngectomy pharyngocutaneous fistula[MeSH Terms]) AND (factor risk[MeSH Terms]) OR factors risk[MeSH Terms]) OR risk factor[MeSH Terms]) OR risk factors[Title/Abstract]) OR causalities[Title/Abstract]) OR causalities[MeSH Terms]) OR multifactorial causality[MeSH Terms]) OR multifactorial causality[Title/Abstract]) OR predisposing factors[Title/Abstract]) OR predisposing factors[MeSH Terms]) OR prognostic factors[MeSH Terms]) OR prognostic factors[Title/Abstract]) OR etiology[Title/Abstract]) OR etiology[MeSH Terms])) AND (laryngectomy[MeSH Terms]) OR laryngectomy[Title/Abstract]) OR pharyngectomy[Title/Abstract]) OR pharyngectomy[MeSH Terms]) OR pharyngolaryngectomy[MeSH Terms]) OR pharyngolaryngectomy[Title/Abstract]) OR laryngectomies[Title/Abstract]) OR laryngectomies[MeSH Terms]) OR neoplasms laryngeal[MeSH Terms]) OR cancer of larynx[MeSH Terms]) OR cancer of larynx[Title/Abstr act]) OR larynx cancer[Title/Abstract]) OR larynx cancer[MeSH Terms]) OR head neck cancer[MeSH Terms]) OR head neck cancer[Title/Abstract]) OR laryngeal cancer[Title/Abstract]) OR laryngeal cancer[MeSH Terms]) OR laryngopharyngectomy[MeSH Terms]) OR laryngopharyngectomy[Title/Abstract]).

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Table 1
- Mean, standard deviation, and p-values of sway velocity (cm/s) and center of pressure area (cm²) in the experimental group of underachieving students and control group (students with good academic performance) in the ten conditions of static Balance Rehabilitation Unit (BRU™).

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Table 2
- Observed association between the presence of risk factors and development of pharyngocutaneous fistula with the univariate and multivariate analysis: (+) uni, observed association with univariate analysis and the multivariate analysis was not performed; (+) uni and (+) multi, an association was observed between the presence of risk factors and development of the pharyngocutaneous fistula in the univariate and multivariate analyzes; (+) uni and (-) multi, observed association in univariate analysis and it was not observed in multivariate analysis; (-) uni and (+) multi, an association was observed in the multivariate analysis and was not observed in the univariate analysis; (-) uni and (-) multi, no association was observed in the univariate and multivariate analysis.

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Table 3
- Summary of studied risk factors for pharyngocutaneous fistula development.

Figure 1 - Flowchart of article selection.
The query used was: (postoperative complications[MeSH Terms]) OR postoperative complications[Title/Abstract]) OR postoperative complication[Title/Abstract]) OR postoperative complication[MeSH Terms]) OR complications, postoperative[MeSH Terms]) OR complications, postoperative[Title/Abstract]) OR complication, postoperative[Title/Abstract]) OR complication, postoperative[MeSH Terms]) OR surgical wound dehiscence[MeSH Terms]) OR surgical wound dehiscence[Title/Abstract]) OR dehiscence surgical wound[Title/Abstract]) OR dehiscence surgical wound[MeSH Terms]) OR anastomotic leaks[MeSH Terms]) OR anastomotic leaks[Title/Abstract]) OR anastomotic leakage[Title/Abstract]) OR anastomotic leakage[MeSH Terms]) OR anastomotic leakage[MeSH Terms]) OR anastomotic leakage[Title/Abstract]) OR healing wound[Title/Abstract]) OR healing wound[MeSH Terms]) OR fistula[MeSH Terms]) OR fistula[Title/Abstract]) OR pharyngocutaneous fistula[Title/Abstract]) OR pharyngocutaneous fistula[MeSH Terms]) OR cutaneous fistula[MeSH Terms]) OR cutaneous fistula[Title/Abstract]) OR skin fistula[Title/Abstract]) OR skin fistula[MeSH Terms]) OR external fistula[MeSH Terms]) OR external fistula[Title/Abstract]) OR salivary gland fistula[Title/Abstract]) OR salivary gland fistula[MeSH Terms]) OR pharyngostoma[MeSH Terms]) OR pharyngostoma[Title/Abstract]) OR postla ryngectomy pharyngocutaneous fistula[Title/Abstract]) OR postlaryngectomy pharyngocutaneous fistula[MeSH Terms]) AND (factor risk[MeSH Terms]) OR factors risk[MeSH Terms]) OR risk factor[MeSH Terms]) OR risk factors[Title/Abstract]) OR causalities[Title/Abstract]) OR causalities[MeSH Terms]) OR multifactorial causality[MeSH Terms]) OR multifactorial causality[Title/Abstract]) OR predisposing factors[Title/Abstract]) OR predisposing factors[MeSH Terms]) OR prognostic factors[MeSH Terms]) OR prognostic factors[Title/Abstract]) OR etiology[Title/Abstract]) OR etiology[MeSH Terms])) AND (laryngectomy[MeSH Terms]) OR laryngectomy[Title/Abstract]) OR pharyngectomy[Title/Abstract]) OR pharyngectomy[MeSH Terms]) OR pharyngolaryngectomy[MeSH Terms]) OR pharyngolaryngectomy[Title/Abstract]) OR laryngectomies[Title/Abstract]) OR laryngectomies[MeSH Terms]) OR neoplasms laryngeal[MeSH Terms]) OR cancer of larynx[MeSH Terms]) OR cancer of larynx[Title/Abstr act]) OR larynx cancer[Title/Abstract]) OR larynx cancer[MeSH Terms]) OR head neck cancer[MeSH Terms]) OR head neck cancer[Title/Abstract]) OR laryngeal cancer[Title/Abstract]) OR laryngeal cancer[MeSH Terms]) OR laryngopharyngectomy[MeSH Terms]) OR laryngopharyngectomy[Title/Abstract]).

Sensory conditions in BRU™	Groups	Sway velocity (cm/s)			Center of pressure area (cm²)
		Mean	SD	p-value	Mean	SD	p-value
1. SS/OE/ no stimulus	Experimental	1.8	0.6	< 0.001^a	9.9	7.2	< 0.001^a
1. SS/OE/ no stimulus	Control	1.3	0.4		4.2	2.2
2. SS/CE	Experimental	2.0	0.5	< 0.001^a	11.0	7.9	< 0.001^a
2. SS/CE	Control	1.6	0.5		5.1	4.0
3. Foam/CE	Experimental	4.0	1.3	< 0.001^a	23.6	11.0	< 0.001^a
3. Foam/CE	Control	3.2	1.1		15.6	8.0
4. SS/Saccadic	Experimental	2.0	0.5	0.024^a	6.1	4.5	0.001^a
4. SS/Saccadic	Control	1.8	0.6		3.6	2.0
5. SS/Bars/Optokinetic to the right	Experimental	2.1	0.6	< 0.001^a	7.9	6.5	< 0.001^a
5. SS/Bars/Optokinetic to the right	Control	1.6	0.6		4.4	2.7
6. SF/Bars/Optokinetic to the left	Experimental	2.3	0.7	< 0.001^a	10.4	6.7	< 0.001^a
6. SF/Bars/Optokinetic to the left	Control	1.8	0.6		4.9	2.9
7. SS/Bars/Optokinetic downward	Experimental	2.5	0.9	< 0.001^a	12.0	11.7	< 0.001^a
7. SS/Bars/Optokinetic downward	Control	1.9	0.6		5.2	2.9
8. SS /Bars/Optokinetic upward	Experimental	2.7	0.9	< 0.001^a	14.2	10.6	< 0.001^a
8. SS /Bars/Optokinetic upward	Control	1.9	0.6		6.9	5.1
9. SF/visual-vestibular/horizontal interaction	Experimental	3.1	0.8	< 0.001^a	16.7	12.5	< 0.001^a
9. SF/visual-vestibular/horizontal interaction	Control	2.3	0.7		8.5	4.6
10. SS/visual-vestibular/vertical interaction	Experimental	3.8	1.3	< 0.001^a	17.9	11.9	< 0.001^a
10. SS/visual-vestibular/vertical interaction	Control	2.8	1.0		10.0	5.2

Risk factors	Association observed				Association not observed
Patient	(+) uni and (+) multi	(+) uni	(+) uni and (-) multi	(-) uni and (+) multi	(-) uni and (-) multi
Gender					17; 11; 6; 15; 12; 13; 14; 16
Age		2; 18; 11			19; 13; 17; 6,21; 5; 15; 22; 12,16; 14; 20
Alcohol	2; 6				17; 16
Smoking					17; 21; 6; 15; 16
Karnofsky		3			20
BMI					20
Loss of weight >10%		4
ASA					16; 4
Comorbidities		15; 30			11; 20; 12; 5
Sepsis		41
DM	4; 25	24			17; 21; 12; 14; 16
COPD	25				14; 16
ICC and HTA	6; 12	36; 14
Hepatopaty	25	17; 24
MI		17
Hb < 12.5 pre	4	2; 24		17	19; 26; 13; 16
Alb < 3.7 pre	4; 17; 25; 14				26; 21
Plaq > 300,000 post	4
Leuc > 11.6 post		5
Fever		2; 27	25; 5
MRSA +	29
Early oral feeding					31; 15; 12; 33; 28; 35
Disease
T stage	18, 32	33			6;17; 36; 25; 21; 24; 31; 15; 29; 30; 22; 13; 12; 14; 16; 20; 11; 28
Advanced N	32;14				10
Supraglot	3	16; 20; 5			34; 18; 23; 21; 2; 15; 29; 12; 10
Glot		20; 5			34; 18; 23; 21; 2; 15; 29; 12; 10
Subglot		20; 5			34; 18; 23; 21; 2; 15; 29; 12; 10
Transglot		20; 5			34; 18; 23; 21; 2; 15; 29; 12; 10
Hypof.	4;17;14	13; 20; 5			31; 34
Grade histol		26			31; 27; 14; 34;18; 30
Treatment
PLT	14; 25	33; 30; 19		3	6
LT				3	15
Laryngec partial		31			15
Rad neck dissection	36; 3	29; 20			16; 31; 25; 34; 23; 21; 18; 27; 14; 32
Neck dissection + RT		19			31
RT pre	36; 6; 3; 31; 28; 16	34; 21; 24; 35; 15; 29; 20; 5; 23	20		19;30;25;33;18;13;11;37 ;27;12;14;10;32;42;2
RT cobalt		20
RT dose		17; 35			21
RT field		17
t'RT surgery	36	35; 20			17
CRT pre	31	21; 35
CRT pre		21			13
Tracheo pre	36	37; 10			23; 24; 18; 15; 13; 2; 27; 12; 14; 32; 5; 34
Pharyngeal myot	27
Type pharyngeal suture		40; 39; 37			9; 29; 7; 21; 22
Suture				3	24; 15; 13; 14; 32
Positive bord infiltration		4; 18; 15			13; 12; 14
Duration surgery	6	16
Blood Transfusion		6; 25; 24
Pharyngeal reconst		13;26			16; 11; 5
Exper Sg	4; 31; 17			3	15; 13
Primary Closure pharynx					26
Tissucol					4
Amylase	25
PTE					23; 2; 18; 11
Complic (hematoma, infec)		18
NSG					27

Significant	Needs more evidence	Not significant
Hemoglobin < 12.5 g/dL pre- and post-surgery	Nutricional deficiency	Gender
	Weight loss > 10 %	Age
		Smoke consumption
Albumin < 3.7 g/L pre- and post-surgery	ASA	T stage
Comorbidities	High consumption of alcohol	Grade of histological differentiation Radical neck dissection
Radiotherapy/chemoradiotherapy pre-surgery	Advanced N stage	Traqueoesophagic puncture
Radiotherapy/chemoradiotherapy pre-surgery	Extension to pharynx/level of the pharyngolaryngeal involvement	Traqueoesophagic puncture
Long duration of surgery	Dose/ radiation field / interval of the time between RT and surgery
Little experience of surgeon	Tracheotomy previous surgery	Neck reconstruction with pedicle flaps
Blood transfusion	Status surgical margins
	Nasogastric tube and oral feeding
	Local wound complications
	Type and pharyngeal suture material

[TFN01t05] BMI, body mass index; DM, diabetes mellitus; COPD, chronic obstructive pulmonary disease; ICC, congestive cardiac disease; HTA, arterial hypertension; MI, myocardial infarction; Hb, hemoglobin; Alb, albumin; Plaq: platelets; Leuc, leucocits; MRSA, methicillin-resistant Staphylococcus aureus; Supraglot, supraglottic; Glot, glottic; subglot, subglottic; Transglot, transglottic; Hipof, hypopharynx; histol, histological; PLT, pharyngolaryngectomy; LT, total laryngectomy; Laryngec, laryngectomy; Rad, radical; RT, radiotherapy; t'RT, interval time betwEen RT and surgery; CRT, chemoradiotherapy; CT, chemotherapy; traqueo, tracheotomy; myot, myotomy; reconst, reconstruction; Exper. Sg, surgeon experience; PTE, tracheoesophagic puncture; Complic, complications; infec, infection; NSG, nasogastric tube; 1 to 43, references number.

Brasil

Brasil

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