Bradykinin receptor B1 and C-reactive protein as prognostic factors for pharyngocutaneous fistula development after laryngectomy

Introduction:

Pharyngocutaneous fistulae are one of the most common complications after laryngectomy. Predisposing risk factors have been multiply analysed, yet knowledge about how to identify patients prone to developing a fistula is still scarce. This study aims to establish prognostic parameters helping to identify individual patients at risk for PCF development. As PCF and inflammation seem to be closely interwoven with one another, the focus of this work is on markers able to detect inflammatory response

Methods:

We retrospectively analysed all patients which had undergone laryngectomy at our clinic in the years 2007 to 2017 (n = 182). Immunohistochemical expression of bradykinin type 1 and 2 receptor and vascular endothelial growth factor receptor 2 was studied in all available tumor samples. Additionally, the clinical inflammation parameters 'body temperature', 'pain', 'c-reactive protein', and 'leucocytes' were postoperatively tracked in all patients.

Results:

We found a strong correlation between inflammation and the formation of a fistula: High B1-R (p = 0.036) and VEGF-R2 (p = 0.003) expression in the tumor samples correlated with postoperative pharyngocutaneous fistula development as well as persistently elevated C-reactive proteins (p = 0.024) and leucocyte (p = 0.026) levels beyond the 6th postoperative day.

Conclusions:

In this study, we identified a subgroup of patients with elevated local and systemic inflammatory markers with significantly increased risk of pharyngocutaneous fistula formation. Those patients need to be closely monitored for fistula formation in order to intervene in good time.

Dr. med. Ulrich Straßen

Klinikum Rechts der Isar/Hals-Nasen-Ohrenklinik,

Ismaninger Straße 22, 81675

München

eMail: [e-mail]

Publikationsverlauf

Publikationsdatum:
23. April 2019 (online)