Predictive factors for the postlaryngectomy pharyngocutaneous fistula development: systematic review,

Objective: Pharyngocutaneous fistula is considered one of the major complications in the postoperative period after total laryngectomy/pharyngolaryngectomy, leading to a severe adverse impact for the patient and society. This study aimed to identify all the described pharyngocutaneous fistula predictive factors and risk classifications. Methods: Research was conducted to identify all the studies assessing predictive factors and risk classification for pharyngocutaneous fistula development published until April of 2012 (n = 846). The included studies were analyzed and data regarding their identification, methodological quality and results were recorded. Results: A total of 39 studies were included. The variables consistently reported as associated with fistula development were nutritional deficiency, American Society of Anesthesiologists (ASA) classification, high consumption of alcohol, anemia and hypoalbuminemia, co-morbidities, advanced N stage, location and extent of primary tumor, pre-radiotherapy and pre-chemoradiotherapy treatment, emergency tracheotomy, surgical margin status, surgery's duration, surgeon's experience, local complications of the wound, performance of intraoperative blood transfusion and relationship between nasogastric tube and oral feeding. Conclusion: Several risk factors were associated with pharyngocutaneous fistula formation in the included studies. However, there is still no consensus in the most pertinent selection. Only two classification systems were retrieved and they were not able to accurately predict pharyngocutaneous fistula.

研究目的：咽皮肤瘘（pharyngocutaneous fistula）被视为全喉切除术/咽喉切除术后的主要并发症之一，会对患者与社会造成严重不良影响。本研究旨在全面梳理目前已报道的咽皮肤瘘预测因素及风险分级方案。
研究方法：本研究系统检索了2012年4月之前发表的、所有评估咽皮肤瘘发生风险预测因素及风险分级的相关研究，共计846项。对纳入的研究进行分析，并记录其研究特征、方法学质量及研究结果相关数据。
研究结果：最终共纳入39项相关研究。经多项研究一致证实与咽皮肤瘘发生相关的变量包括：营养缺乏、美国麻醉医师协会（American Society of Anesthesiologists, ASA）分级、大量饮酒史、贫血与低白蛋白血症、合并症、N分期晚期、原发肿瘤的位置与侵犯范围、术前放疗及术前放化疗、急诊气管切开、手术切缘状态、手术时长、术者经验、伤口局部并发症、术中输血情况，以及鼻胃管与经口进食的干预时机关系。
研究结论：纳入的研究显示多种风险因素与咽皮肤瘘的形成相关，但目前尚未就最具临床相关性的风险因素筛选达成共识。本研究仅检索到2种风险分级体系，且二者均无法准确预测咽皮肤瘘的发生。