Objective To investigate the risk factors of pharyngocutaneous fistula (PCF) after total laryngectomy for hypopharyngeal cancer. Methods The clinical data of 89 hypopharyngeal cancer patients, who underwent total laryngectomy in The Affiliated Cancer Hospital of Nanjing Medical University from Jan.2009 to Dec.2019, were retrospectively analyzed.The patients were divided into PCF group and non-PCF group.The risk factors of PCF related to patient, disease, and treatment were analyzed. Results Among the 89 patients, 20 cases had postoperative PCF and 69 had no PCF.The overall incidence of PCF was 22.5%.Univariate analysis showed that the proportions of patients with diabetes mellitus (P=0.031), preoperative chemoradiotherapy (P=0.021), preoperative hypoalbuminemia (P=0.008), postoperative hypoalbuminemia (P=0.002), and flap repair (P=0.034) in the PCF group were significantly higher than those in the non-PCF group.Multivariate logistic regression analysis showed that postoperative albumin level was an independent protective factor for PCF (odds ratio=0.174, 95% confidence interval 0.048-0.626, P=0.007). Conclusion The hypopharyngeal cancer patients with diabetes mellitus, perioperative hypoalbuminemia, or preoperative chemoradiotherapy are more likely to develop PCF after total larynegctomy.