{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:14:07Z","timestamp":1791656047225,"version":"4.3.4"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007363","name":"Stiftelsen Acta Oto-Laryngologica","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007363","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the prevalence and identify associated risk factors of pharyngocutaneous fistula following total laryngectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Medical records of 160 patients diagnosed with laryngeal cancer between 2000\u20132021, subsequently undergoing total laryngectomy at Karolinska University Hospital, were analyzed for demographics, comorbidities, tumor characteristics, treatments and postoperative outcomes. Uni- and multivariate analyses were used to identify risk factors for pharyngocutaneous fistula.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Pharyngocutaneous fistula developed in 28 patients (17.5%). Univariate analysis identified cardiovascular disease (OR 2.50; 95% CI 1.00\u20136.28), preoperative hemoglobin &lt;110 g\/L (OR 5.34; 95% CI 1.74\u201316.45), prior radiotherapy (OR 3.78; 95% CI 1.24\u201311.52), preoperative tracheostomy (OR 2.44; 95% CI 1.05\u20135.72), pharyngectomy (OR 8.47; 95% CI 2.46\u201329.17), neck dissection (OR 2.52; 95% CI 1.06\u20136.00), pectoral flap reconstruction (OR 10.83; 95% CI 1.88\u201362.49) and postoperative infection (OR 28.44; 95% CI 9.00\u201389.81) as significant risk factors. In multivariate analysis only pharyngectomy (OR 7.18; 95% CI 1.08\u201347.63; p\u2009=\u20090.041) and postoperative infection (OR 24.94; 95% CI 6.66\u201393.46; p\u2009&lt;\u20090.001) remained independent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pharyngocutaneous fistula is a common complication occurring in 17.5% of patients following total laryngectomy. Pharyngectomy and postoperative infection are independent risk factors for fistula formation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0348792","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T17:29:07Z","timestamp":1780421347000},"page":"e0348792","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pharyngocutaneous fistula after total laryngectomy: Prevalence and risk factors"],"prefix":"10.1371","volume":"21","author":[{"given":"Petronella","family":"Pettersson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasmus","family":"Blomkvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3844-5999","authenticated-orcid":true,"given":"Krzysztof","family":"Piersiala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elin","family":"Marsk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Elliot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Palmgren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claes","family":"Mercke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Marklund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9325-2992","authenticated-orcid":true,"given":"Rusana","family":"Bark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"pone.0348792.ref001","unstructured":"Swedish Head and Neck Cancer Register (Swe-HNCR), Presentation in English. 2020 [cited 2025 Jul 1]. Available from: https:\/\/cancercentrum.se\/download\/18.3de350c219545ea25bd220e1\/1741017690273\/presentation-in-english-swehncr.pdf"},{"issue":"6","key":"pone.0348792.ref002","first-page":"394","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"F Bray","year":"2018","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"pone.0348792.ref003","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1002\/hed.23834","article-title":"Laryngeal cancer in Finland: a 5-year follow-up study of 366 patients","volume":"38","author":"A Haapaniemi","year":"2016","journal-title":"Head Neck"},{"key":"pone.0348792.ref004","first-page":"11","article-title":"Cancer statistics, 2013","volume":"63","author":"R Siegel","year":"2013","journal-title":"CA Cancer J 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