The Effect of Halp Score on the Development of Pharyngocutaneous Fistula After Laryngectomy

Year 2025, Volume: 9 Issue: 2, 158 - 165, 31.08.2025

Deniz Baklacı , Duygu Erdem , Seda Nur Saka , Gökhan Furkan Kılıç , Doğancan Eralp

https://doi.org/10.29058/mjwbs.1577524

Abstract

Aim: Laryngeal cancers are prominent among head and neck cancers, and laryngectomy is commonly performed in advanced cases.
Pharyngocutaneous fistula (PCF), a postoperative complication, negatively impacts quality of life, prolongs hospitalization, and delays treatment.
The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, calculated from hemoglobin, albumin, lymphocyte, and platelet
levels, reflects immune and nutritional status. Material and Methods: This retrospective study included 76 patients who underwent surgery for laryngeal cancer between January 2012
and June 2024. Patients were grouped based on partial or total laryngectomy, and HALP scores were compared with the incidence of fistula.
Results: In the total laryngectomy group, the mean HALP score was 33.42±17.17 for patients without fistula and 42.79±30.00 for those with
fistula. No statistically significant difference was found between the two groups (p>0.05).
Conclusion: No significant relationship was found between HALP score and PCF development. However, since hemoglobin and albumin
may be risk factors, larger, multicenter prospective studies are needed for a more comprehensive evaluation

Keywords

HALP score , laryngectomy , pharyngocutaneous fistula

Ethical Statement

The study received ethical approval from the ethics committee of our hospital (Date: 21.02.2024, number: 2024/05) and the study protocol was conducted in accordance with the 1964 Helsinki Declaration.

Larenjektomi Sonrası Faringokutanöz Fistül Gelişimi Üzerine Halp Skoru Etkisi

Abstract

Amaç: Larengeal kanserler, baş ve boyun kanserleri içinde önemli bir yer tutar ve ileri evre hastalarda genellikle larenjektomi uygulanır.
Cerrahiden sonra gelişebilen farengokütanöz fistül (FKF), yaşam kalitesini düşürür, hastanede kalış süresini uzatır ve tedavi sürecini aksatır.
Hemoglobin, Albumin, Lenfosit ve Platelet (HALP) skoru; hemoglobin, albümin, lenfosit ve trombosit parametrelerinin kullanıldığı, immün ve
beslenme durumunu yansıtan bir biyomarkerdir.
Gereç ve Yöntemler: Ocak 2012 - Haziran 2024 tarihleri arasında kliniğimizde larenks kanseri nedeniyle opere edilen 76 hasta retrospektif
olarak değerlendirildi. Hastalar, kısmi veya total larenjektomi geçirmelerine göre gruplandırıldı ve HALP skorları ile fistül gelişimi karşılaştırıldı.
Bulgular: Total larenjektomi yapılan ve fistül gelişmeyen hastaların ortalama HALP skoru 33.42±17.17, fistül gelişenlerin ise 42.79±30.00
idi. Ancak gruplar arasında istatistiksel olarak anlamlı fark saptanmadı (p>0.05).
Sonuç: HALP skoru ile FKF gelişimi arasında anlamlı bir ilişki bulunmadı. Ancak hemoglobin ve albümin düzeylerinin risk faktörü olabileceği
göz önünde bulundurularak, bu ilişkiyi değerlendirmek için daha geniş, çok merkezli ve prospektif çalışmalara ihtiyaç vardır.

Keywords

Faringokutanöz fistül , HALP skoru , larenjektomi

Ethical Statement

Çalışma, hastanemizin etik kurulundan etik onay almıştır (Tarih: 21.02.2024, numara: 2024/05) ve çalışma protokolü 1964 Helsinki Deklarasyonu'na uygun olarak gerçekleştirilmiştir.

Supporting Institution

Yok.

Thanks

Yok.

References

• 1. National Cancer Institute. SEER: cancer stat facts: larynx cancer [Internet]. 2018 [cited 2018 Feb 10]. Available from: http:// seer.cancer.gov/statfacts/html/laryn.html
• 2. Obid R, Redlich M, Tomeh C. The treatment of laryngeal cancer. Oral Maxillofac Surg Clin North Am. 2019;31(1):1–11. doi: 10.1016/j.coms.2018.09.001.
• 3. Andaloro C, Widrich J. Total laryngectomy [Internet]. In: Stat- Pearls. Treasure Island (FL): StatPearls Publishing; 2024 – [updated 2023; cited 2025]. Available from: https://www.ncbi. nlm.nih.gov/books/NBK556041/.
• 4. Jones TM, De M, Foran B, Harrington K, Mortimore S. Laryngeal cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016; 130(S2):S75–S82. doi: 10.1017/ S0022215116000487.
• 5. Chen XL, Xue L, Wang W, Chen HN, Zhang WH, Liu K, Chen XZ, Yang K, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;6(38):41370-82. doi: 10.18632/oncotarget.5629.
• 6. Jiang H, Li H, Li A, Tang E, Xu D, Chen Y, Zhang Y, Tang M, Zhang Z, Deng X, Lin M. Preoperative combined hemoglobin, albumin, lymphocyte and platelet levels predict survival in patients with locally advanced colorectal cancer. Oncotarget. 2016;7(44):72076-72083. doi: 10.18632/oncotarget.12271.
• 7. Matsui Y, Matsuda A, Maejima A, Shinoda Y, Nakamura E, Komiyama M, Fujimoto H. The clinical significance of perioperative inflammatory index as a prognostic factor for patients with retroperitoneal soft tissue sarcoma. Int J Clin Oncol. 2022; 27(6):1093-1100. doi: 10.1007/s10147-022-02150-8. Epub 2022.
• 8. Arikan T, Sozuer E, Topal U, Lale A, Yılmaz A. The value and prognostic significance of preoperative hemoglobin and albumin levels, and the lymphocyte and platelet count (HALP) scores in predicting pancreatic fistula in patients undergoing pancreaticoduodenectomy due to periampullary region tumors. Acta Med Mediterr. 2021;37:1341. doi: 10.19193/0393- 6384_2021_2_206.
• 9. Tarle M, Čvrljević I, Raguž M, Lukšić I. Hemoglobin-Albumin- Lymphocyte-Platelet (HALP) score as a predictive model for the success of reconstruction of head and neck defects with free microvascular flaps. J Clin Med. 2023;12(16):5314. doi:10.3390/jcm12165314.
• 10. Nitassi S, Belayachi J, Chihab M, Rkain I, Benayad J, Benbouzid MA, Oujilal A, Essakalli L. Evaluation of Post Laryngectomy Pharyngocutaneous Fistula risk Factors. Iran J Otorhinolaryngol. 2016;28(85):141-7. doi:10.22038/IJORL.2016.6561.
• 11. Šifrer R, Aničin A, Pohar MP, Žargi M, Pukl P, Soklič T, Strojan P. Pharyngocutaneous fistula: the incidence and the risk factors. Eur Arch Otorhinolaryngol. 2016 ;273(10):3393-9. doi: 10.1007/s00405-016-3963-z. Epub 2016.
• 12. Thawley SE. Complications of combined radiation therapy and surgery for carcinoma of the larynx and inferior hypopharynx. Laryngoscope. 1981;91(5):677-700. doi:10.1288/00005537- 198105000-00001.
• 13. Bresson K, Rasmussen H, Rasmussen PA. Pharyngo-cutaneous fistulae in totally laryngectomized patients. The Journal of Laryngology & Otology. 1974;88(9):835-842. doi:10.1017/ S0022215100079433.
• 14. Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP’s prognostic ability in different cancer types. Oncotarget. 2023;14:153–172. doi: 10.18632/oncotarget.28367.
• 15. Scotton W, Cobb R, Pang L, Nixon I, Joshi A, Jeannon JP, Oakley R, French G, Hemsley C, Simo R. Post-operative wound infection in salvage laryngectomy: does antibiotic prophylaxis have an impact? Eur Arch Otorhinolaryngol. 2012;269(11):2415-22. doi: 10.1007/s00405-012-1932-8. Epub 2012.
• 16. Redaelli de Zinis LO, Ferrari L, Tomenzoli D, Premoli G, Parrinello G, Nicolai P. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Head Neck. 1999;21(2):131-8. doi: 10.1002/(sici)1097- 0347(199903)21:2<131::aid-hed6>3.0.co;2-f.
• 17. Kiliç C, Tuncel U, Cömert E. Pharyngocutaneous fistulae after total laryngectomy: analysis of the risk factors and treatment approaches. B-ENT. 2015;11(2):95–100.
• 18. Liang, J. W., Li, Z. D., Li, S. C., Fang, F. Q., Zhao, Y. J., & Li, Y. G. (2015). Pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis of risk factors. Auris, nasus, larynx, 42(5), 353–9. https://doi.org/10.1016/j. anl.2015.04.002.
• 19. Dedivitis RA, Aires FT, Cernea CR, Brandão LG. Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors. Head & neck. 2015;37(11):1691–7. https://doi. org/10.1002/hed.23804.
• 20. Paydarfar JA, Birkmeyer NJ. Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula. Archives of otolaryngology--head & neck surgery. 2006;132(1): 67–72. https://doi.org/10.1001/archotol.132.1.67.
• 21. Lemaire E, Schultz P, Vergez S, Debry C, Sarini J, Vairel B, de Bonnecaze G, Takeda-Raguin C, Cabarrou B, Dupret-Bories A. Risk factors for pharyngocutaneous fistula after total pharyngolaryngectomy. Ear Nose Throat 2021;100(5_suppl): 746S–752S. doi: 10.1177/0145561319901035.
• 22. Fradis M, Podoshin L, Ben David J. Post-laryngectomy pharyngocutaneous fistula--a still unresolved problem. The Journal of laryngology and otology. 1995;109(3): 221–4. https://doi. org/10.1017/s0022215100129743.
• 23. Morton RP, Mehanna H, Hall FT, McIvor NP. Prediction of pharyngocutaneous fistulas after laryngectomy. Otolaryngology-- head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2007;136(4 Suppl):46–9. https://doi.org/10.1016/j.otohns.2006.11.030.
• 24. Varlotto J, Stevenson MA. Anemia, tumor hypoxemia, and the cancer patient. International journal of radiation oncology, biology, physics. 2005;63(1):25–36. https://doi.org/10.1016/j. ijrobp.2005.04.049.
• 25. Jing X, Yang F, Shao C, Wei K, Xie M, Shen H, Shu Y. Role of hypoxia in cancer therapy by regulating the tumor microenvironment. Mol Cancer. 2019;18(1):157. https://doi.org/10.1186/ s12943-019-1089-9.
• 26. Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med. 2004;116 Suppl 7A:11S-26S. https://doi.org/10.1016/j. amjmed.2003.12.008.
• 27. Xia L, Guzzo TJ. Preoperative Anemia and Low Hemoglobin Level Are Associated With Worse Clinical Outcomes in Patients With Bladder Cancer Undergoing Radical Cystectomy: A Meta-Analysis. Clin Genitourin Cancer. 2017;15(2):263-272. e4. https://doi.org/10.1016/j.clgc.2016.08.017.
• 28. Huang XZ, Yang YC, Chen Y, Wu CC, Lin RF, Wang ZN, Zhang X. Preoperative Anemia or Low Hemoglobin Predicts Poor Prognosis in Gastric Cancer Patients: A Meta-Analysis. Dis Markers. 2019;2019:7606128. doi: 10.1155/2019/7606128.
• 29. Dai D, Han S, Li L, Guo Y, Wei Y, Jin H, Wang X. Anemia is associated with poor outcomes of metastatic castration-resistant prostate cancer, a systematic review and meta-analysis. Am J Transl Res. 2018;10(12):3877-3886.
• 30. Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, Neeser O, Huber A, Stanga Z, Mueller B, Schuetz P. Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: a prospective study. Am J Med. 2020;133:713–722.e7. doi: 10.1016/j.amjmed.2019.10.031.
• 31. Sheinenzon A, Shehadeh M, Michelis R, Shaoul E, Ronen O. Serum albumin levels and inflammation. Int J Biol Macromol. 2021;184:857–862. doi: 10.1016/j.ijbiomac.2021.06.140.
• 32. McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013;39:534–540. doi: 10.1016/j. ctrv.2012.08.003.
• 33. Nakashima K, Hata K, Hotta T, Tanaka S, Mitarai Y, Okuno T, Tanino A, Nakao M, Amano Y, Hamaguchi M, Okimoto T, Hamaguchi S, Nagao T. Ability of the Glasgow Prognostic Score to predict the tolerability and efficacy of platinum-combination chemotherapy among elderly patients with advanced non-small cell lung cancer. J Med Invest. 2021;68:260–264. doi: 10.2152/jmi.68.260.
• 34. Farag CM, Antar R, Akosman S, Ng M, Whalen MJ. What is hemoglobin, albumin, lymphocyte, platelet (HALP) score? A comprehensive literature review of HALP’s prognostic ability in different cancer types. Oncotarget. 2023;14:153–72. doi: 10.18632/oncotarget.28367.
• 35. Gay LJ, Felding-Habermann B. Contribution of platelets to tumour metastasis. Nat Rev Cancer. 2011;11:123–134. doi: 10.1038/nrc3004.
• 36. Pinedo HM, Verheul HM, D’Amato RJ, Folkman J. Involvement of platelets in tumour angiogenesis? Lancet. 1998;352:1775– 1777. doi: 10.1016/S0140-6736(98)05095-8.
• 37. Möhle R, Green D, Moore MA, Nachman RL, Rafii S. Constitutive production and thrombin-induced release of vascular endothelial growth factor by human megakaryocytes and platelets. Proc Natl Acad Sci U S A. 1997;94:663–8. doi: 10.1073/ pnas.94.2.663.
• 38. Folkman J. Tumor angiogenesis: therapeutic implications. N Engl J Med. 1971;285:1182–6. doi: 10.1056/ NEJM197111182852108.
• 39. Palacios-Acedo AL, Mège D, Crescence L, Dignat-George F, Dubois C, Panicot-Dubois L. Platelets, thrombo-inflammation, and cancer: collaborating with the enemy. Front Immunol. 2019;10:1805. doi: 10.3389/fimmu.2019.01805.
• 40. Duzkopru Y, Kocanoglu A, Yigitbay M, Dogan O, Sahinli H, Yazilitas D. Analyzing HALP and PNI scores as prognostic factors in metastatic head and neck cancers. Asian J Surg. 2024:S1015- 9584(24)00755-3. doi: 10.1016/j.asjsur.2024.04.093. Epub ahead of print.
• 41. Wenig BL, Stegnjajic A, Abramson AL. Glottic reconstruction following conservation laryngeal surgery. Laryngoscope. 1989;99(9):983-5. doi: 10.1288/00005537-198909000-00014.