The effect of salivary bypass tube use on the prevention of pharyngo-cutaneous fistulas after total laryngectomy

Introduction The aim of this retrospective study was to assess the efficacy of Salivary Bypass Tube (SBT) for preventing pharyngo-cutaneous fistula (PCF) in a recent cohort of patients who underwent primary and salvage total laryngectomy (TL). Methods A consecutive series of 133 patients who underwent total laryngectomy between 1997 and 2019 was reviewed. The incidence of PCF was compared between patients who did not receive SBT (nSBT group; n = 55) and those preventively receiving SBT (SBT group; n = 78) in both primary and salvage TL. Risk factors for PCF were evaluated in a univariate and multivariate analyses. Results The overall PCF rate was 30%. Preoperative characteristics were similar between the nSBT and SBT groups, except for older age ( p = 0.016), lower preoperative hemoglobin ( p = 0.043), and lesser neoadjuvant chemotherapy ( p = 0.015) in the SBT group. The rate of PCF the nSBT group, was 41.5%, compared to 21.8% in the SBT group ( p = 0.020). In multivariate analysis, only the use of SBT was associated with lower risk of PCF (OR = 0.41 (95% CI 0.19–0.89), p = 0.026). This effect was verified only in the subgroup of patient operated for salvage TL (OR = 0.225; 95% CI 0.09–0.7; p = 0.008). Conclusion The use of SBT in our series in salvage TL, appears to be associated with a decreased risk of PCF.