This is a meta-analysis looking at the postoperative pharyngocutaneous fistula rates following total laryngectomy. The authors ended up with 34 studies with about 2500 patients. The most striking finding was that preoperative radiotherapy was a significant risk factor as well as positive margins and a postoperative haemoglobin of less than 12.5g/L. The authors also suggest tumour subsite (supraglottic v glottic) and T stage although these seem less clear cut. I wonder if the skill of the surgeon is a major risk factor particularly in view of the fact that the fistula rate ranged from 7.4% to 58%! One for another study perhaps.