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Comparative Study
. 2012 Apr;34(4):557-67.
doi: 10.1002/hed.21777. Epub 2011 Jun 20.

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

Katherine A Hutcheson  1 , Jan S Lewin, Erich M Sturgis, Jan Risser
Affiliations
Comparative Study

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

Katherine A Hutcheson et al. Head Neck. 2012 Apr.

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 (OR(adjusted) , 3.2; 95% CI, 1.2-8.6), and diagnosis of locoregional recurrence or distant metastasis after laryngectomy (OR(adjusted) , 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.

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Figures

Figure 1
Figure 1. Risk-Stratified Kaplan-Meier Estimates for Enlarged TEP
Abbreviations: TEP, tracheoesophageal puncture; “high-risk”, patients who had any of the 3 primary risk factors identified in the final multivariable logistic regression model (advanced nodal staging, postoperative stricture, or locoregional recurrence or distant metastasis after laryngectomy); “low risk”, patients who had none of the 3 primary risk factors.
See this image and copyright information in PMC

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