Komplikationen nach Laryngektomie – Biermann Medizin


Das Auftreten einer pharyngokutanen Fistel zählt zu den häufigsten Komplikationen nach Laryngektomie. Eine Studie hat Entstehung und Risikofaktoren systematisch evaluiert.

Frühere Arbeiten deuteten darauf hin, dass es besonders nach Radiotherapien und Radiochemotherapien zu Komplikationen wie pharyngokutanen Fisteln kommen kann.

Ein Team chinesicher Otolaryngologen hat nun in einem kürzlich in den „European Archives of Oto-Rhino-Laryngology“ publizierten Review die Entstehung von pharyngokutanen Fisteln sowie die asso­ziierten Risikofaktoren systematisch evaluiert; hierfür wurden die Datenbanken Pubmed, Web of Science, Cochrane Library sowie Embase nach Literatur bezüglich der Einschluss- und Ausschlusskriterien durchsucht. Es konnten insgesamt 52 Studien mit 8605 inkludierten Patienten für die Metaanalyse gefunden werden. Die Gesamtinzidenz für pharyngokutane Fisteln betrug 21 % (1808/8605).

Die Resultate der Metaanalyse zeigten, dass

  • das Alter (Chancenverhältnis [OR] 1,29; 95 %-Konfidenzintervall [KI] 1,06–1,58)
  • der Rauchstatus (OR 1,62; 95 %-KI 1,27–2,07)
  • das Vorliegen einer COPD (OR 1,62; 95 %-KI 1,19–2,22)
  • das Vorliegen einer koronaren Herzerkrankung (OR 1,82; 95 %-KI 1,36–2,45)
  • das Tumorstadium bzgl. Größe und Ausbreitung (OR 0,81; 95 %-KI 0,67–0,98)
  • frühere Bestrahlungstherapien (OR 2,41; 95 %-KI 2,00–2,90)
  • der präoperative Albuminlevel (OR 2,95; 95 %-KI 1,47–5,91)
  • der präoperative Hämoglobinlevel (OR 1,97; 95 %-KI 1,28–3,03)
  • die Tumorlokalisation (OR 0,28; 95 %-KI 0,22–0,36)
  • sowie die Behandlungsmethode (OR 1,85; 95 %-KI 1,44–2,38)

die wesentlichen Risikofaktoren für das Auftreten einer pharyngokutanen Fistel nach kompletter Laryngektomie darstellen.

Die Autoren bilanzieren: Fortgeschrittenes Alter, Rauchen, COPD, KHK, Tumorlokalisation und Tumorstadium, präoperative Albumin- und Hämoglobinwerte sowie die Art der Therapie stellen Risikofaktoren für pharyngokutane Fisteln dar. (am)

Wang et al. Risk factors of pharyngocutaneous fistula after total laryngectomy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020;277(2):585–599.

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