Incidencia y factores de riesgo de las fístulas faringocutáneas tras laringectomía total. Revisión bibliográfica
Resumen Introducción y objetivo: La fístula faringocutánea tras la laringectomía total es una complicación que conlleva un incremento de la morbilidad y mortalidad. Realizamos una revisión con el objetivo de identificar los factores que implican un aumento de su incidencia. Método: Se realizó una revisión de 31 artículos con un total 1100 pacientes con esta complicación, recogiéndose su incidencia del total de laringectomías totales realizadas, así como los factores de riesgo asociados a su aparición. Resultados: La incidencia de esta complicación se estima en un 22,3% con un rango que oscila de un 3 al 65% entre todas las series incluidas en la revisión. De la totalidad de factores de riesgo implicados, el que aparece con mayor frecuencia es la radioterapia preoperatoria, seguida de la comorbilidad asociada, hipoalbuminemia, anemia y antecedentes de traqueotomía previa a la laringectomía. Discusión: Los pacientes irradiados tienen mayor número de faringostomas. Aun así, según las series estudiadas, hay una heterogeneidad en los resultados pues en algunas no se encuentra relación, lo que podría explicarse por la asociación con otros factores de riesgo. Conclusiones: La incidencia en la formación de fístulas faringocutáneas es muy variable y existe un gran número de factores de riesgo implicados siendo el más frecuente la radioterapia asociada o no a quimioterapia.
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1. Busoni M, Deganello A, Gallo O. Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities. Acta Otorhinolaryngol Ital. 2015;35(6):400-5.
2. Saki N, Nikakhlagh S, Kazemi M. Pharyngocutaneous fistula after laryngectomy: incidence, predisposing factors, and outcome. Arch Iran Med. 2008;11(3):314-7.
3. Toyama F, Aparecido R, Ferrari MA, Araki D, Cernea CR, Garcia L. Pharyngocutaneous fistula following total laryngectomy. Braz. j. Otorhinolaryngoly 2012;78 (6):94-8.
4. Pantvaidya GH, Raina S, Mondal A, et al. Total laryngectomy: Surgical morbidity and outcomes - A case series. Indian J Cancer. 2017;54(4):621-5.
5. Asif Ali Arain, Mubasher Ikram, Shabbir Akhtar, Muhammad Shaheryar Ahmed Rajput, Mohammad Adeel, Moaz Maqbool Choudhary. Frequency and predisposing factors of pharyngocutaneous fistula after total laryngectomy. Egyptian Journal of Ear, Nose, Throat and Allied Science 2013;14 (2):103-6.
6. Shams El-din, Mohammed. The incidence and risk factors of pharyngocutaneous fistula after total laryngectomy. Al-azhar Assiut Medical Journal. 2014:12.
7. Suzuki S, Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Yamasoba T. Pharyngocutaneous fistula and delay in free oral feeding after pharyngolaryngectomy for hypopharyngeal cancer. Head Neck. 2016;38 Suppl 1:E625-E630.
8. Aires FT, Dedivitis RA, Castro MA, Ribeiro DA, Cernea CR, Brandão LG. Fístula faringocutânea após laringectomia total [Pharyngocutaneous fistula following total laryngectomy]. Braz J Otorhinolaryngol. 2012;78(6):94-8.
9. Markou KD, Vlachtsis KC, Nikolaou AC, Petridis DG, Kouloulas AI, Daniilidis IC. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?. Eur Arch Otorhinolaryngol. 2004;261(2):61-7.
10. Mattioli F, Bettini M, Molteni G, et al. Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status. Acta Otorhinolaryngol Ital. 2015;35(4):243-8.
11. Benson EM, Hirata RM, Thompson CB, et al. Pharyngocutaneous fistula after total laryngectomy: a single-institution experience, 2001-2012. Am J Otolaryngol. 2015;36(1):24-31.
12. Nitassi S, Belayachi J, Chihab M et al. Evaluation of post laryngectomy pharyngocutaneous fistula risk factors. Iran J Otorhinolaryngol. 2016;28(85):141–7.
13. Kiliç C, Tuncel U, Cömert E. Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches. B-ENT. 2015;11(2):95-100.
14. Akduman D, Naibo?lu B, Uslu C, et al. Total larenjektomi sonrasi farengokutanöz fistül: Sikli?i, etkileyen faktörler ve tedavi yakla?imi [Pharyngocutaneous fistula after total laryngectomy: incidence, predisposing factors, and treatment]. Kulak Burun Bogaz Ihtis Derg. 2008;18(6):349-54.
15. Hall FT, O'Brien CJ, Clifford AR, McNeil EB, Bron L, Jackson MA. Clinical outcome following total laryngectomy for cancer. ANZ J Surg. 2003;73(5):300-5.
16. Lansaat L, van der Noort V, Bernard SE, et al. Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit. Eur Arch Otorhinolaryngol. 2018;275(3):783-94.
17. Güçlü E, Pinar E, Oncel S, Calli C. Total larenjektomi sonrasinda farengokutanöz fistül sikli?i ve risk faktörlerinin analizi [Pharyngocutaneous fistula after total laryngectomy: incidence and analysis of risk factors]. Kulak Burun Bogaz Ihtis Derg. 2007;17(5):260-4.
18. Asl?er NGY, Do?an E, Asl?er M, ?kiz AÖ. Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking. Turk Arch Otorhinolaryngol. 2016;54(3):91-8.
19. Timmermans AJ, Lansaat L, Theunissen EA, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Predictive factors for pharyngocutaneous fistulization after total laryngectomy. Ann Otol Rhinol Laryngol. 2014;123(3):153-61.
20. Dedivitis RA, Ribeiro KC, Castro MA, Nascimento PC. Pharyngocutaneous fistula following total laryngectomy. Acta Otorhinolaryngol Ital. 2007;27(1):2-5.
21. Sousa Ade A, Porcaro-Salles JM, Soares JM, et al. Predictors of salivary fistula after total laryngectomy. Rev Col Bras Cir. 2013;40(2):98-103.
22. Fernández-Prada M, Palomeque-Vera JM, Gómez-Hervás J, Guillén Solvas J, Sainz Quevedo M, Revelles Suárez H. Incidencia, estancia hospitalaria y factores de riesgo asociados a la aparición de fístula faringocutánea poslaringectomía [Incidence, hospital stay and risk factors associated with the occurrence of pharyngo-cutaneous fistula after total laryngectomy]. Acta Otorrinolaringol Esp. 2014;65(1):22-6.
23. White HN, Golden B, Sweeny L, Carroll WR, Magnuson JS, Rosenthal EL. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope. 2012;122(8):1796-19.
24. Süslü N, ?efik Ho?al A. Early oral feeding after total laryngectomy: Outcome of 602 patients in one cancer center. Auris Nasus Larynx. 2016;43(5):546-50.
25. Cavalot AL, Gervasio CF, Nazionale G, et al. Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records. Otolaryngol Head Neck Surg. 2000;123(5):587-92.
26. Boscolo-Rizzo P, De Cillis G, Marchiori C, Carpenè S, Da Mosto MC. Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy. Eur Arch Otorhinolaryngol. 2008;265(8):929-6.
27. Ganly I, Patel S, Matsuo J, et al. Postoperative complications of salvage total laryngectomy. Cancer. 2005;103(10):2073-81.
28. Mäkitie AA, Niemensivu R, Hero M, et al. Pharyngocutaneous fistula following total laryngectomy: a single institution's 10-year experience. Eur Arch Otorhinolaryngol. 2006;263(12):1127-30.
29. Galli J, De Corso E, Volante M, Almadori G, Paludetti G. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Otolaryngol Head Neck Surg. 2005;133(5):689-94.
30. Sarra LD, Rodríguez JC, García Valea M, Bitar J, Da Silva A. Fístula tras laringectomía total. Estudio retrospectivo y revisión bibliográfica [Fistula following total laryngectomy. Retrospective study and bibliographical review]. Acta Otorrinolaringol Esp. 2009;60(3):186-9.
31. Virtaniemi JA, Kumpulainen EJ, Hirvikoski PP, Johansson RT, Kosma VM. The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae. Head Neck. 2001;23(1):29-33.
32. Lebo NL, Caulley L, Alsaffar H, Corsten MJ, Johnson-Obaseki S. Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort. J Otolaryngol Head Neck Surg. 2017;46(1):54.
33. Liang JW, Li ZD, Li SC, Fang FQ, Zhao YJ, Li YG. Pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis of risk factors. Auris Nasus Larynx. 2015;42(5):353-9.
34. Redaelli de Zinis LO, Ferrari L, Tomenzoli D, et al. Postlaryngectomypharyngocutaneous fistula: incidence, predisposing factors, and therapy. Head Neck 1999;21(2):131– 8.
35. Trinidad G, Luengo JM, Marcos M, Pardo G, González A, Pino A, et al. Utilidad del soporte nutricional en pacientes con fístula faringocutánea. Act Otol Esp. 2005;56: 25-30.
36. Schwartz SR, Yueh B, Maynard C, Daley J, Henderson W, Khuri SF. Predictors of wound complications after laryngectomy: A study of over 2000 patients. Otolaryngol Head Neck Surg. 2004;131:61–8.
37. Lebo NL, Caulley L, Alsaffar H, Corsten MJ, Johnson-Obaseki S. Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort. J Otolaryngol Head Neck Surg. 2017;46(1):54.
38. Soylu L, Kiroglu M, Aydogan B, Cetik F, Kiroglu F, Akcali C, et al. Pharyngocutaneous fistula following laryngectomy. Head Neck. 1998;20:22-5.
39. Horgan EC, Dedo HH. Prevention of major and minor fistulae after laryngectomy. Laryngoscope 1979;89: 251–60.
40. Violaris N, Bridger M. Prophylactic antibiotics and post larygectomy pharyngocutaneous fistulae. J Laryngol Otol 1990;104:225–8.
41. Saydam L, Kalcioglu T, Kizilay A. Early oral feeding following total laryngectomy. Am J Otolaryngol. 2002;23(5):277-81.
42. Hanasono MM, Lin D, Wax MK, Rosenthal EL. Closure of laryngectomy defects in the age of chemoradiation therapy. Head Neck. 2012; 34:580–8.
2. Saki N, Nikakhlagh S, Kazemi M. Pharyngocutaneous fistula after laryngectomy: incidence, predisposing factors, and outcome. Arch Iran Med. 2008;11(3):314-7.
3. Toyama F, Aparecido R, Ferrari MA, Araki D, Cernea CR, Garcia L. Pharyngocutaneous fistula following total laryngectomy. Braz. j. Otorhinolaryngoly 2012;78 (6):94-8.
4. Pantvaidya GH, Raina S, Mondal A, et al. Total laryngectomy: Surgical morbidity and outcomes - A case series. Indian J Cancer. 2017;54(4):621-5.
5. Asif Ali Arain, Mubasher Ikram, Shabbir Akhtar, Muhammad Shaheryar Ahmed Rajput, Mohammad Adeel, Moaz Maqbool Choudhary. Frequency and predisposing factors of pharyngocutaneous fistula after total laryngectomy. Egyptian Journal of Ear, Nose, Throat and Allied Science 2013;14 (2):103-6.
6. Shams El-din, Mohammed. The incidence and risk factors of pharyngocutaneous fistula after total laryngectomy. Al-azhar Assiut Medical Journal. 2014:12.
7. Suzuki S, Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Yamasoba T. Pharyngocutaneous fistula and delay in free oral feeding after pharyngolaryngectomy for hypopharyngeal cancer. Head Neck. 2016;38 Suppl 1:E625-E630.
8. Aires FT, Dedivitis RA, Castro MA, Ribeiro DA, Cernea CR, Brandão LG. Fístula faringocutânea após laringectomia total [Pharyngocutaneous fistula following total laryngectomy]. Braz J Otorhinolaryngol. 2012;78(6):94-8.
9. Markou KD, Vlachtsis KC, Nikolaou AC, Petridis DG, Kouloulas AI, Daniilidis IC. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?. Eur Arch Otorhinolaryngol. 2004;261(2):61-7.
10. Mattioli F, Bettini M, Molteni G, et al. Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status. Acta Otorhinolaryngol Ital. 2015;35(4):243-8.
11. Benson EM, Hirata RM, Thompson CB, et al. Pharyngocutaneous fistula after total laryngectomy: a single-institution experience, 2001-2012. Am J Otolaryngol. 2015;36(1):24-31.
12. Nitassi S, Belayachi J, Chihab M et al. Evaluation of post laryngectomy pharyngocutaneous fistula risk factors. Iran J Otorhinolaryngol. 2016;28(85):141–7.
13. Kiliç C, Tuncel U, Cömert E. Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches. B-ENT. 2015;11(2):95-100.
14. Akduman D, Naibo?lu B, Uslu C, et al. Total larenjektomi sonrasi farengokutanöz fistül: Sikli?i, etkileyen faktörler ve tedavi yakla?imi [Pharyngocutaneous fistula after total laryngectomy: incidence, predisposing factors, and treatment]. Kulak Burun Bogaz Ihtis Derg. 2008;18(6):349-54.
15. Hall FT, O'Brien CJ, Clifford AR, McNeil EB, Bron L, Jackson MA. Clinical outcome following total laryngectomy for cancer. ANZ J Surg. 2003;73(5):300-5.
16. Lansaat L, van der Noort V, Bernard SE, et al. Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit. Eur Arch Otorhinolaryngol. 2018;275(3):783-94.
17. Güçlü E, Pinar E, Oncel S, Calli C. Total larenjektomi sonrasinda farengokutanöz fistül sikli?i ve risk faktörlerinin analizi [Pharyngocutaneous fistula after total laryngectomy: incidence and analysis of risk factors]. Kulak Burun Bogaz Ihtis Derg. 2007;17(5):260-4.
18. Asl?er NGY, Do?an E, Asl?er M, ?kiz AÖ. Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking. Turk Arch Otorhinolaryngol. 2016;54(3):91-8.
19. Timmermans AJ, Lansaat L, Theunissen EA, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Predictive factors for pharyngocutaneous fistulization after total laryngectomy. Ann Otol Rhinol Laryngol. 2014;123(3):153-61.
20. Dedivitis RA, Ribeiro KC, Castro MA, Nascimento PC. Pharyngocutaneous fistula following total laryngectomy. Acta Otorhinolaryngol Ital. 2007;27(1):2-5.
21. Sousa Ade A, Porcaro-Salles JM, Soares JM, et al. Predictors of salivary fistula after total laryngectomy. Rev Col Bras Cir. 2013;40(2):98-103.
22. Fernández-Prada M, Palomeque-Vera JM, Gómez-Hervás J, Guillén Solvas J, Sainz Quevedo M, Revelles Suárez H. Incidencia, estancia hospitalaria y factores de riesgo asociados a la aparición de fístula faringocutánea poslaringectomía [Incidence, hospital stay and risk factors associated with the occurrence of pharyngo-cutaneous fistula after total laryngectomy]. Acta Otorrinolaringol Esp. 2014;65(1):22-6.
23. White HN, Golden B, Sweeny L, Carroll WR, Magnuson JS, Rosenthal EL. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope. 2012;122(8):1796-19.
24. Süslü N, ?efik Ho?al A. Early oral feeding after total laryngectomy: Outcome of 602 patients in one cancer center. Auris Nasus Larynx. 2016;43(5):546-50.
25. Cavalot AL, Gervasio CF, Nazionale G, et al. Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records. Otolaryngol Head Neck Surg. 2000;123(5):587-92.
26. Boscolo-Rizzo P, De Cillis G, Marchiori C, Carpenè S, Da Mosto MC. Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy. Eur Arch Otorhinolaryngol. 2008;265(8):929-6.
27. Ganly I, Patel S, Matsuo J, et al. Postoperative complications of salvage total laryngectomy. Cancer. 2005;103(10):2073-81.
28. Mäkitie AA, Niemensivu R, Hero M, et al. Pharyngocutaneous fistula following total laryngectomy: a single institution's 10-year experience. Eur Arch Otorhinolaryngol. 2006;263(12):1127-30.
29. Galli J, De Corso E, Volante M, Almadori G, Paludetti G. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Otolaryngol Head Neck Surg. 2005;133(5):689-94.
30. Sarra LD, Rodríguez JC, García Valea M, Bitar J, Da Silva A. Fístula tras laringectomía total. Estudio retrospectivo y revisión bibliográfica [Fistula following total laryngectomy. Retrospective study and bibliographical review]. Acta Otorrinolaringol Esp. 2009;60(3):186-9.
31. Virtaniemi JA, Kumpulainen EJ, Hirvikoski PP, Johansson RT, Kosma VM. The incidence and etiology of postlaryngectomy pharyngocutaneous fistulae. Head Neck. 2001;23(1):29-33.
32. Lebo NL, Caulley L, Alsaffar H, Corsten MJ, Johnson-Obaseki S. Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort. J Otolaryngol Head Neck Surg. 2017;46(1):54.
33. Liang JW, Li ZD, Li SC, Fang FQ, Zhao YJ, Li YG. Pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis of risk factors. Auris Nasus Larynx. 2015;42(5):353-9.
34. Redaelli de Zinis LO, Ferrari L, Tomenzoli D, et al. Postlaryngectomypharyngocutaneous fistula: incidence, predisposing factors, and therapy. Head Neck 1999;21(2):131– 8.
35. Trinidad G, Luengo JM, Marcos M, Pardo G, González A, Pino A, et al. Utilidad del soporte nutricional en pacientes con fístula faringocutánea. Act Otol Esp. 2005;56: 25-30.
36. Schwartz SR, Yueh B, Maynard C, Daley J, Henderson W, Khuri SF. Predictors of wound complications after laryngectomy: A study of over 2000 patients. Otolaryngol Head Neck Surg. 2004;131:61–8.
37. Lebo NL, Caulley L, Alsaffar H, Corsten MJ, Johnson-Obaseki S. Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort. J Otolaryngol Head Neck Surg. 2017;46(1):54.
38. Soylu L, Kiroglu M, Aydogan B, Cetik F, Kiroglu F, Akcali C, et al. Pharyngocutaneous fistula following laryngectomy. Head Neck. 1998;20:22-5.
39. Horgan EC, Dedo HH. Prevention of major and minor fistulae after laryngectomy. Laryngoscope 1979;89: 251–60.
40. Violaris N, Bridger M. Prophylactic antibiotics and post larygectomy pharyngocutaneous fistulae. J Laryngol Otol 1990;104:225–8.
41. Saydam L, Kalcioglu T, Kizilay A. Early oral feeding following total laryngectomy. Am J Otolaryngol. 2002;23(5):277-81.
42. Hanasono MM, Lin D, Wax MK, Rosenthal EL. Closure of laryngectomy defects in the age of chemoradiation therapy. Head Neck. 2012; 34:580–8.
Sanz-Sánchez, C. I., Kraemer-Baeza, E., Aguilar-Conde, M. D., Flores-Carmona, E., & Cazorla-Ramos, O. E. (2020). Incidencia y factores de riesgo de las fístulas faringocutáneas tras laringectomía total. Revisión bibliográfica. Revista ORL, 12(1), 55–65. https://doi.org/10.14201/orl.23703
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