Fistula faringocutânea: análise de incidencia, fatores de risco e medidas de prevenção em hospital escola.

Introduction: Laryngeal cancer is one of the most important of the cases of head and neck cancer, accounting for about 25% of all cases of head and neck cancer in the United States .In our population total laryngectomy is presented as important form of treatment of laryngeal cancer, bringing with it one of the most morbid and problematic complications, pharyngocutaneous fistula, whose incidence varies in the literature, may range from 3% to 65%) depending on the analyzed source. Objectives: To analyze the population treated in our service by laryngeal tumors, to determine our rates pharyngocutaneous fistula, its risk factors and ways to prevenção. Método: 104 patients, 83 men and 21 women were analyzed, aged between 43 and 83 years (mean 61.7 years) treated between July 2009 and June 2014. All patients underwent total laryngectomy or full pharyngolaryngectomy as a treatment of squamous cell carcinomas of larynx (T2: 8 cases, T3: 21 cases, T4: 73 cases). In order to investigate possible risk factors evaluated the following criteria: Age, hematocrit (from 35.0 to 47.0%), serum albumin (3.4 to 4.8 g / dL), hormone Tireo - Stimulating / TSH serum (0.27 to 4.20 μIU / mL), preoperative BMI (18.5 to 25 kg / m²), Tumor stage (TNM), Patchwork Use the Neo-pharynx, the Neo-closing type pharynx (absorbable suture Manual polyglactine or Mechanical with Linear Cutting Stapler). Results: Analysis of our data showed a 38.5% fistula rate in our population, consistent with the literature mundial. Dentre all factors analyzed, only three statistically relevant: serum albumin, tumor stage and use of linear stapler. The serum albumin concentration in these patients, with values less than or equal to 2.7 g / dl had rates of 77.8% fistula (p = 0.001), placing the albumin of less than 2.7 g / dL as a risk factor for pharyngocutaneous fistula formation with about five times more likely to fistula formation (OR = 5.519). The stadium you are in the initial tumor patient also showed a significant influence on fistula rates, with the most advanced stages (stage 4) presented fistula rate of 43.8%, against 20.8% of the earliest stages (stages 2 and 3) with p = 0.035. The use of stapler presented fistula rates (without stapler use: 48.7% versus with stapler use: 10.7%, p = 0.000), which allow us to put it as a protective factor against the formation of fistulas (OR = 0.181). Conclusion: The results of this study allow us to conclude that for the formation of pharyngocutaneous fistula, serum albumin below 2.7 g / dL and the advanced stage (stage IV) are important risk factors, and the use of mechanical suture by linear stapler a strong protective factor. [ABSTRACT FROM AUTHOR]