Original Article

Multivariable analysis of risk factors for enlargement of the tracheoesophageal puncture after total laryngectomy

  1. Katherine A. Hutcheson PhD1,*,
  2. Jan S. Lewin PhD1,
  3. Erich M. Sturgis MD, MPH1,2,
  4. Jan Risser PhD3

Article first published online: 20 JUN 2011

DOI: 10.1002/hed.21777

Issue

Head & Neck

Head & Neck

Volume 34, Issue 4, pages 557–567, April 2012

Additional Information

How to Cite

Hutcheson, K. A., Lewin, J. S., Sturgis, E. M. and Risser, J. (2012), Multivariable analysis of risk factors for enlargement of the tracheoesophageal puncture after total laryngectomy. Head Neck, 34: 557–567. doi: 10.1002/hed.21777

Author Information

  1. 1

    Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas

  2. 2

    Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas

  3. 3

    Division of Epidemiology and Disease Control, The University of Texas School of Public Health, Houston, Texas

*Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas

Publication History

  1. Issue published online: 3 MAR 2012
  2. Article first published online: 20 JUN 2011
  3. Manuscript Accepted: 15 FEB 2011

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Keywords:

  • tracheoesophageal puncture;
  • total laryngectomy;
  • enlarged tracheoesophageal puncture;
  • risk factors

Abstract

Background

Enlarged tracheoesophageal puncture (TEP) is a challenging complication of surgical prosthetic voice restoration. Prevention of this complication requires identification of high-risk individuals, and surgical and prosthetic correlates of TEP enlargement.

Methods

Multivariable logistic regression methods were used to analyze preoperative, perioperative, and postoperative risk factors for enlarged TEP in a 5-year retrospective cohort.

Results

Enlarged TEP only occurred in irradiated patients. Adjusting for length of follow-up and timing of TEP, advanced (N2 or N3) nodal disease (odds ratio [OR]adjusted, 4.3; 95% confidence interval [CI], 1.0–19.1), postoperative stricture (ORadjusted, 3.2; 95% CI, 1.2–8.6), and diagnosis of locoregional recurrence or distant metastasis after laryngectomy (ORadjusted, 6.2; 95% CI, 2.3–16.4) increased risk of enlarged TEP. Extended resection and preoperative nutritional status were also significantly associated with enlarged TEP. Prosthetic parameters did not significantly correlate with enlargement.

Conclusion

Development of enlarged TEP is a multifactorial process related to both baseline and postoperative factors. © 2011 Wiley Periodicals, Inc. Head Neck, 2012

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