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Meta-Analysis
. 2011 Jan;33(1):20-30.
doi: 10.1002/hed.21399.

Enlarged tracheoesophageal puncture after total laryngectomy: a systematic review and meta-analysis

Katherine A Hutcheson  1 , Jan S Lewin, Erich M Sturgis, Asha Kapadia, Jan Risser
Affiliations
Meta-Analysis

Enlarged tracheoesophageal puncture after total laryngectomy: a systematic review and meta-analysis

Katherine A Hutcheson et al. Head Neck. 2011 Jan.

Abstract

Background: Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure.

Methods: A systematic review was conducted (1978-2008). A summary risk estimate was calculated using a random-effects meta-analysis model.

Results: Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP-site injections were the most commonly reported conservative treatments. Prosthetic diameter (p = .076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported.

Conclusion: The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management.

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Figures

Figure 1
Figure 1
Forest plot for rate of enlarged TEP/leakage around the voice prosthesis (VP; n = 19).
See this image and copyright information in PMC

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