556 Audit of Pharyngocutaneous Fistula Incidence Following Laryngectomy: A Retrospective Study at Royal Devon & Exeter Hospital

Aim This audit aimed to evaluate the incidence of Pharyngocutaneous Fistula (PCF) after laryngectomy at Royal Devon & Exeter Hospital and identify potential predictors for its development, aiding in better preoperative counselling and postoperative care. Method Conducted between December 2020 and May 2023, this retrospective audit reviewed records of laryngectomy patients. Data on demographics, comorbidities, tumour characteristics, surgical techniques, and postoperative outcomes were analysed, focusing primarily on PCF incidence and potential predictors. Results The study involved 45 patients (82.2% male, 17.8% female, average age 69). PCF was observed in 20% of cases (66% in upfront, 33% in salvage cases). Patients with PCF had longer hospital stays (24.5 v/s 11.1 days) A majority (82.2%) were smokers or ex-smokers. Leak rates varied with the type of surgical flap used and were lower in upfront cases compared to salvage cases. Trends were observed correlating smoking and PCF incidence. PCFs developed more commonly with pec major than ALT flaps. Clear margins were less frequently obtained in supraglottic than glottic disease (45% v/s 93%). Conclusions While the incidence of PCF aligns with existing literature, this audit suggests the need to explore risk factors beyond smoking. The influence of surgical flaps on leak rates, though apparent, warrants further study due to the small sample size. Future research should investigate broader factors influencing PCF and assess the effectiveness of different surgical techniques in preventing leaks. The study also recommends a re-audit and broader exploration of the role of nodal disease and surgical margins in PCF occurrence.