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10.3390/jcm12051851
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Article

Improved Early Detection Models of Pharyngocutaneous Fistula after Total Laryngectomy

by
Yujin Heo
1,†,
Hyun Suk Lee
2,†,
Sungha Jung
1,
Changhee Lee
1,
Younghac Kim
1,
Man Ki Chung
1,
Han-Sin Jeong
1,
Chung-Hwan Baek
1,
Joong Hyun Ahn
3,
Young-Ik Son
1,* and
Nayeon Choi
1,*
1
Department of Otorhinolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
2
Department of Internal Medicine-Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
3
Biomedical Statistics Center, Institute of Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2023, 12(5), 1851; https://doi.org/10.3390/jcm12051851
Submission received: 7 January 2023 / Revised: 17 February 2023 / Accepted: 22 February 2023 / Published: 26 February 2023
(This article belongs to the Section Otolaryngology)
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Abstract

Early detection of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) could prevent severe complications such as major vessel rupture. We aimed to develop prediction models for detecting PCF in the early postoperative period. We retrospectively analyzed patients (N = 263) who received TL between 2004 and 2021. We collected clinical data for fever (>38.0 °C) and blood tests (WBC, CRP, albumin, Hb, neutrophils, lymphocytes) on postoperative days (POD) 3 and 7, and fistulography on POD 7. Clinical data were compared between fistula and no fistula groups, and significant factors were selected using machine learning. Using these clinical factors, we developed improved prediction models for PCF detection. Fistula occurred in 86 (32.7%) patients. Fever was significantly (p < 0.001) more common in the fistula group, and ratios (POD 7 to 3) of WBC, CRP, neutrophils, and neutrophils-to-lymphocytes (NLR) were significantly higher (all p ≤ 0.001) in the fistula group than in the no fistula group. Leakage on fistulography was more common in the fistula group (38.2%) than in the no fistula group (3.0%). The area under curve (AUC) of fistulography alone was 0.68, but predictive models using a combination of fistulography, WBC at POD 7, and neutrophil ratio (POD 7/POD 3) showed better diagnostic performance (AUC of 0.83). Our predictive models may detect PCF early and accurately, which could reduce fatal complications following PCF.
Keywords: total laryngectomy; pharyngocutaneous fistula; early detection; method; fistulography total laryngectomy; pharyngocutaneous fistula; early detection; method; fistulography

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MDPI and ACS Style

Heo, Y.; Lee, H.S.; Jung, S.; Lee, C.; Kim, Y.; Chung, M.K.; Jeong, H.-S.; Baek, C.-H.; Ahn, J.H.; Son, Y.-I.; et al. Improved Early Detection Models of Pharyngocutaneous Fistula after Total Laryngectomy. J. Clin. Med. 2023, 12, 1851. https://doi.org/10.3390/jcm12051851

AMA Style

Heo Y, Lee HS, Jung S, Lee C, Kim Y, Chung MK, Jeong H-S, Baek C-H, Ahn JH, Son Y-I, et al. Improved Early Detection Models of Pharyngocutaneous Fistula after Total Laryngectomy. Journal of Clinical Medicine. 2023; 12(5):1851. https://doi.org/10.3390/jcm12051851

Chicago/Turabian Style

Heo, Yujin, Hyun Suk Lee, Sungha Jung, Changhee Lee, Younghac Kim, Man Ki Chung, Han-Sin Jeong, Chung-Hwan Baek, Joong Hyun Ahn, Young-Ik Son, and et al. 2023. "Improved Early Detection Models of Pharyngocutaneous Fistula after Total Laryngectomy" Journal of Clinical Medicine 12, no. 5: 1851. https://doi.org/10.3390/jcm12051851

APA Style

Heo, Y., Lee, H. S., Jung, S., Lee, C., Kim, Y., Chung, M. K., Jeong, H.-S., Baek, C.-H., Ahn, J. H., Son, Y.-I., & Choi, N. (2023). Improved Early Detection Models of Pharyngocutaneous Fistula after Total Laryngectomy. Journal of Clinical Medicine, 12(5), 1851. https://doi.org/10.3390/jcm12051851

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