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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Prior radiotherapy (OR 1.6\u20134.2), 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>Risk stratification, preoperative optimization, and surgical techniques such as flap reinforcement reduce PCF risk and improve postoperative outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00405-026-10157-4","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:12:09Z","timestamp":1782087129000},"page":"4609-4618","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pharyngocutaneous fistula following total laryngectomy: a systematic review of risk factors and management strategies (2010\u20132024)"],"prefix":"10.1007","volume":"283","author":[{"given":"Elisabet","family":"Gomis-Lleal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Sampieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9-Miguel","family":"Costa-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Vilaseca-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco-Xavier","family":"Avil\u00e9s-Jurado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8191-9833","authenticated-orcid":false,"given":"Manuel","family":"Bernal-Sprekelsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"issue":"12","key":"10157_CR1","first-page":"1675","volume":"31","author":"A Agraval","year":"2009","unstructured":"Agraval A, Moon J, Mell L et al (2009) Transoral resection followed by radiation therapy for head and neck cancer: results of a prospective study. 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As such, he has not been involved neithr in the review nor in decision process.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"There is no ethical approval needed because no human or animal subjects were involved. Subsequently, there was no need for informed consents or for approval by the IRB.","order":2,"name":"Ethics","label":"Ethical","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors do no have conflicts of interest in relation with this manuscript.","order":3,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}