The incidence of PCF is significantly increased in patients with COPD, CAD, diabetes mellitus, previous radiation or chemoradiation, preoperative low albumin or hemoglobin, salvage surgery, extended total laryngectomy (including pharyngectomy), positive surgical margins, postoperative hypoproteinemia, and early oral feeding [10,11,12,13]. This evidence concerns the gene ALB and chronic obstructive pulmonary disease.