The Relative Analysis Between Nutritional Risk And Pharyngocutaneous Fistula

Objective: To explore the relationship and diagnostic value between accessing the preoperative risk of nutrition in patients with hypopharyngeal carcinoma and the pharyngocutaneous fistula after the surgery.Methods: To review the 77 cases of patient with hypopharyngeal carcinoma according with our criteria retrospectively,which receiving the therapy in head and neck surgery in Guangxi medical university affiliated tumor hospital between the January 2013 and January 2018.Analyzing the risk factors for the pharyngocutaneous fistula after surgery which contained diabetes history,preoperative nutritional risk,history of smoking,history of alcohol intake,blood type difference,preoperative radiotherapy,pre-operative chemotherapy,preoperative hemoglobin counting,skin flap for repairing,operation time,surgical methods,time of keeping stomach tube,T-stage,N-stage,tumor locations,neck dissection.Dividing the selected patients into two group by the NRS scores,the nutrition risk group(NRS≥3)and the no nutrition risk group(NRS<3).Doing the single-factor analysis and the binary logistics regression analysis by SPSS19.0.Counting the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and area under the ROC curve of the preoperative NRS2002 scores which served as diagnostic criteria were calculated compared with the results with the "golden standard" of pharyngocutaneous fistula.Result: Among the 77 cases of hypopharyngeal carcinoma,The patients of NRS≥3 group and NRS<3 group were 33 and 44 respectively,nearly 42.9%patients with a risk of nutrition before surgery.Pharyngocutaneous fistula occurring in the former group was 10,which accounted for 83.3% of the overall cases,while 2 patients were in the second group,representing only 16.7%among all cases.After the single analysis,we find that the risk factors of pharyngocutaneous fistula with statistical significance are preoperative nutritional risk(NRS2002)(P < 0.01),the T-stage(P < 0.05),preoperative hemoglobin counting(P<0.05),neck dissection(P<0.05)and the duration of operation(P < 0.05).After the binary Logistics analysis indicated that the preoperative nutritional(P=0.005,OR=22.345,95%CI=2.525-197.737)and T-stage(P=0.046,OR=9.671,95%CI=1.040-89.941)are the independent risk factors for Pharyngocutaneous fistula after surgery.The sensitivity and specificity are 76% and 80% respectively while the accuracy is 67.4%,with the positive predictive value 83.3%,negative predictive value 64.6% and area under the ROC curve 0.860.Conclusion: From our study,we conclude that the preoperative nutritional risk(NRS2002),T-stage,preoperative hemoglobin counting,neck dissection and duration of operation are the risk factors of Pharyngocutaneous fistula after surgery while the nutritional risk and T-stage are the independent risk factors.NRS2002 can be used for evaluating the nutritional status before surgery and having the diagnostic value for pharyngocutaneous fistula.In general,the key point to prevent the pharyngocutaneous fistula after the surgery that is to screenand early diagnose the nutritional risk in the preoperational period by using the NRS2002 which may improve the patients’ quality of life and upgrading the prognosis in the future.