O010

Friday, November 14th, 2025 17:09 – 17:17
Speaker Mariana Caetano

Risk factors and oncological impact of postoperative complications after total laryngectomy

Objectives: To analyze the incidence of postoperative complications after total laryngectomy, identify associated risk factors, and assess their impact on oncological outcomes.
Methods: We retrospectively reviewed consecutive patients undergoing total laryngectomy for laryngeal squamous cell carcinoma at a tertiary referral center (2014–2024). Demographic, pathological, and treatment variables were analyzed in relation to postoperative complications, with special focus on pharyngocutaneous fistula. Associations with adjuvant therapy compliance, recurrence, and survival were also assessed.
Results: Postoperative complications occurred in 34.4% of patients. The most frequent was pharyngocutaneous fistula (26.7%), followed by surgical site infection (4.4%) and lower respiratory tract infection (3.3%). On univariable analysis, prior radiotherapy, close or positive surgical margins, and lymphovascular invasion were associated with increased risk of fistula (p=0.065, p=0.080, and p=0.024, respectively). In multivariable analysis, prior radiotherapy remained an independent predictor (adjusted OR 3.59; 95% CI 1.11–11.61; p=0.033). Pharyngocutaneous fistula was not significantly associated with completion of planned adjuvant radiotherapy or chemoradiotherapy (81.8% vs. 85.7%; p=0.73). However, it was associated with increased risk of local or distant recurrence (42.3% vs. 24.6%; p=0.049) and significantly worse overall survival (5-year OS 28.3% vs. 46.7%; log-rank p=0.038).
Conclusions: Pharyngocutaneous fistula continues to represent a major postoperative challenge after total laryngectomy, particularly in patients with prior radiotherapy. Beyond prolonging recovery, its occurrence carries significant oncological implications, being associated with higher recurrence rates and worse overall survival. These findings emphasize the need for tailored perioperative strategies and close follow-up in high-risk patients.