Evaluation of amylase levels in the neck drainage and serum for early diagnosis of the pharyngocutaneous fistula.

OBJECTIVES: To assess the value of amylase levels in neck drainage and serum for the diagnosis of pharyngocutaneous fistula in the early postoperative period. PATIENTS AND METHODS: We conducted a prospective study in a tertiary referral setting. Thirty-two patients (31 males, 1 female; mean age 63; range 45 to 75 years) who had laryngectomy operation as the primary treatment were studied. Amylase levels in the neck drainage and serum were analyzed in the first three postoperative days. The results were compared between patients who developed pharyngocutaneous fistula and who did not. RESULTS: Serum amylase levels were significantly higher in pharyngocutaneous fistula group, whereas amylase in the neck drainage was not diagnostic. CONCLUSION: Serum amylase levels may be used in laryngectomy patients for the early diagnosis of pharyngocutaneous fistula.

Prediction of pharyngocutaneous fistulas after laryngectomy.

OBJECTIVE: To assess the predictive value of wound amylase as an indicator for pharyngocutaneous fistula development following laryngectomy for cancer. DESIGN AND SETTING: We conducted a prospective observational study at a tertiary referral center of 102 consecutive laryngeal or hypopharyngeal cancer patients undergoing laryngectomy with or without pharyngectomy. INTERVENTION: Data were collated on potential predictors of fistula formation compared with rate of development of clinical fistulas, all confirmed radiologically. MAIN OUTCOME MEASURES: Rate of fistula formation was determined for the following potential predictors: extent of resection (extended laryngectomy), postoperative wound (drain) amylase, previous radiotherapy, neck dissection, preoperative and postoperative hemoglobin and albumin levels, and postoperative transfusion. Sensitivity, specificity, and positive and negative predictive values of significant predictors were ascertained. RESULTS: The only significant predictors of fistula formation were extent of resection (extended laryngectomy) and drain amylase >4000 IU/L. If both factors are combined, the sensitivity, specificity, and positive and negative predictive values for fistula development are 83, 94, 63, and 98 percent, respectively. CONCLUSION: We advocate that patients be managed postoperatively according to the presence or absence of these given predictors to reduce occurrence of fistula formation in the high-risk group.