This study investigated the risk factors for developing pharyngocutaneous fistula, the most common complication following total laryngectomy.

We included all patients who underwent total laryngectomy and bilateral neck dissection from 2009 to 2021. Patients excluded were those with hypopharyngeal involvement, total or partial pharyngectomy, base of the tongue resection, large pharyngeal defects requiring free/pedicle flap reconstruction, or salvage laryngectomy.

A total of 164 patients participated in the study. Multivariate regression analysis identified two independent predictors of pharyngocutaneous fistula formation: pharyngeal reconstruction with simple interrupted sutures (odds ratio: 3.12, 95 per cent confidence interval: 1.31–17.00, p = 0.010) and radical neck dissection (odds ratio: 3.16, 95 per cent confidence interval: 1.13–8.82, p = 0.028).

Our findings suggest that pharyngeal reconstruction using simple interrupted sutures and radical neck dissection are independent risk factors for pharyngocutaneous fistula development. Based on this, we recommend using the modified Cushing suture technique over simple interrupted sutures due to its association with a significantly lower pharyngocutaneous fistula rate.