Pharyngocutaneous fistula following total laryngectomy: a systematic review of risk factors and management strategies (2010–2024)

IMPORTANCE: Pharyngocutaneous fistula (PCF) is the most common and morbid complication after total laryngectomy (TL). OBJECTIVE: To systematically identify predictive factors and effective interventions for PCF. DATA SOURCES: PubMed search of English-language studies published between 2010 and 2024. STUDY SELECTION: Twenty-one observational cohort studies involving ≥25 adult patients undergoing TL and reporting PCF outcomes. DATA SYNTHESIS: Narrative synthesis and descriptive analysis were performed due to heterogeneity in study design and outcome measures. Risk of bias was assessed using the ROBINS-I tool, and the certainty of evidence for each risk factor was rated according to GRADE methodology. FINDINGS: Prior radiotherapy (OR 1.6-4.2), hypoalbuminemia, preoperative tracheostomy, and surgical closure without flap reinforcement were major risk factors for PCF. Conservative management succeeded in ~70% of cases. Flap reconstruction had higher success rates (~90%). Evidence certainty ranged from high (e.g., prior radiotherapy, hypoalbuminemia) to very low (e.g., antibiotic protocols), as summarized in a GRADE-based synthesis. CONCLUSIONS AND RELEVANCE: Risk stratification, preoperative optimization, and surgical techniques such as flap reinforcement reduce PCF risk and improve postoperative outcomes.