Outcomes and adverse events of enlarged tracheoesophageal puncture after total laryngectomy

Authors

  • Katherine A. Hutcheson PhD,

    Corresponding author
    1. Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas
    • The University of Texas M. D. Anderson Cancer Center, P. O. Box 301402, Department of Head and Neck Surgery, Unit 1445, Houston, Texas 77030
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  • Jan S. Lewin PhD,

    1. Department of Head and Neck Surgery, The University of Texas, M. D. 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, M. D. Anderson Cancer Center, Houston, Texas
    2. Department of Epidemiology, The University of Texas, M. D. 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, U.S.A
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  • Presented at the Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A., January 27–29, 2011.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Enlargement of the tracheoesophageal puncture (TEP) results in aspiration around the voice prosthesis (VP) and may lead to pneumonia. The primary objective was to summarize control of leakage around the VP after conservative management of enlarged TEP.

Study Design:

Retrospective cohort study.

Methods:

This 5-year cohort included 194 patients who underwent total laryngectomy (with or without pharyngectomy) and TEP at the University of Texas MD Anderson Cancer Center. Control of leakage around the VP was analyzed at last follow-up after enlarged TEP. Adverse events were compared in patients with and without enlarged TEP.

Results:

The incidence of enlarged TEP was 18.6% (36 of 194, 95% confidence interval [CI]: 13.0%-24.1%). Conservative methods commonly attempted in lieu of complete TEP closure included placement of an enlarged-flange VP (34 of 36, 94%), temporary VP removal (14 of 36, 39%), and TEP-site injection (8 of 36, 22%). At last follow-up, conservative methods controlled leakage around the VP in 81% (29 of 36) of patients. Only two patients required complete TEP closure due to persistent leakage after enlarged TEP. Unresolved leakage was more common in patients with recurrent cancer after laryngectomy (P = .081) and irregular TEP contour (P = .003). Relative to controls without TEP enlargement, patients with enlarged TEP had a three-fold higher risk of pneumonia (relative risk: 3.4, 95% CI: 1.9–6.2) and aspiration of the prosthesis (relative risk: 3.3, 95% CI: 0.8–14.1).

Conclusions:

Although the rate of enlarged TEP is relatively low, the complication significantly elevates risk of pneumonia. Prosthetic leakage related to TEP enlargement can often be managed conservatively to avoid complete closure of the TEP.

Ancillary