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

Authors

  • Katherine A. Hutcheson PhD,

    Corresponding author
    1. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
    • Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Jan S. Lewin PhD,

    1. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Erich M. Sturgis MD, MPH,

    1. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
    2. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Jan Risser PhD

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