BrazJOtorhinolaryngol.2015;81(6):687
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
Letter
to
the
Editor
夽Carta
ao
editor
DearEditor,
I am writing to you in reference to a very thought pro-vokingarticle titled ‘Derivation ofa clinical decision rule for predictive factors for the development of pharyngo-cutaneousfistula postlaryngectomy’byCecatto etal.,1in
youresteemedjournal.Thearticleiswellwritten;however, therearesomemorefactorsintheetiologyof pharyngocu-taneousfistulathattheauthorshavenotanalyzedandthat couldaffecttheoutcome,whichIwouldliketohighlight.
The etiology of pharyngocutaneous fistula is multifac-torial, which has been proven by multiple studies2 and
reviews.3 There are several additional proven significant
factorsintheetiologyofpharyngocutaneousfistula,which havenotbeenanalyzedinthisstudy,suchasintra-operative blood transfusion,3 surgical duration,3 and presence of
hypothyroidism.4 The inclusion of these may change the
multivariateanalysisandultimatelytheconclusion. The study is very novel and the development of clin-ical decision rule for pharyngocutaneous fistula is quite commendable. But there is concern regarding the samp-lingof the patients; for instance, thenumber ofpatients receiving pre-operative chemoradiotherapy (CRT), just 15 (8.8%),which is toosmallfor deriving a conclusion,since CRT has proven to be one of the most significant factors indevelopmentofpharyngocutaneousfistula.3,4 Thestudy
alsoincludesfewpatientswithstageIdisease,who under-went laryngectomy. This does not adhere to the current guideline, and therefore these patients could have been excluded.
夽 Pleasecitethisarticleas:BakshiSS.LettertotheEditor.BrazJ
Otorhinolaryngol.2015;81:687.
The stratification of patientsintorisk groups is agood ideaforeconomicuseofresources,butifwestudythe strat-ificationcarefully,thesensitivityforhigh-riskgroupsisjust 48%,whichis lowfor suchan importantcomplicationand castsadoubtonitsclinicalapplication.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
References
1.Cecatto SB, Soares MM, Henriques T, Monteiro E, Moura CI. Derivationofa clinicaldecisionrulefor predictivefactors for thedevelopmentofpharyngocutaneousfistulapostlaryngectomy. Braz JOtorhinolaryngol. 2015;81:394---401,http://dx.doi.org/ 10.1016/j.bjorl.2014.09.009.
2.AiresFT,DedivitisRA,CastroMA,RibeiroDA,CerneaCR,Brandão LG.Pharyngocutaneousfistulafollowingtotallaryngectomy.Braz JOtorhinolaryngol.2012;78:94---8.
3.Cecatto SB, Soares MM, Henriques T, Monteiro E, Moura CI. Predictivefactorsforthepostlaryngectomypharyngocutaneous fistuladevelopment:systematicreview.BrazJOtorhinolaryngol. 2014;80:167---77.
4.WhiteHN,GoldenB,SweenyL,CarrollWR,MagnusonJS, Rosen-thal EL. Assessment and incidence of salivary leak following laryngectomy. Laryngoscope. 2012;122:1796---9, http://dx.doi. org/10.1002/lary.23443.
SatvinderSinghBakshi
DepartmentofENTandHead&NeckSurgery,Mahatma GandhiMedicalCollegeandResearchInstitute,
Pillaiyarkuppam,India E-mail:saty.bakshi@gmail.com
http://dx.doi.org/10.1016/j.bjorl.2015.08.002
