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.