Abstract Objective: The aim of this study was to determine the incidence and risk factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) at a single institution. Design: Retrospective analysis the symptoms and risk factors for pharyngocutaneous fistula after total laryngectomy in a general hospital from 2011 to 2021. Results: PCF occurred in 27 patients (20.0%, 27/135). In medical history, neck dissection (OR=6.202; 95% CI 2.204-17.453; [P=0.001]) and BMI (OR=1.284; 95%CI 1.096-1.504; [P=0.002]) were associated with the occurrence of PCF. In the preoperative experimental examination, ALP (OR=1.075; 95%CI 1.032-1.12; [P=0.001]) and LY% (OR=1.186; 95%CI 1.063-1.322; [P=0.002]. Factors commonly associated with PCF, such as age, male gender, preoperative radiotherapy, low hemoglobin, smoking and inflammatory markers, were not statistically significant in this study. Conclusion: Our data portray the primary factors as a patient’s BMI is greater than 19.38, an LY% greater than 30.05, and an ALP greater than 78.5 and neck dissection were associated with an increased risk of PCF. This study shows a critical balance in adjusting the sensitivity and specificity of guidelines to improve patient outcomes.