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

作者：Hutcheson Katherine A^*; Lewin Jan S; Sturgis Erich M; Risser Jan

来源：Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 2012, 34(4): 557-567.

DOI：10.1002/hed.21777

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

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. %26lt;br%26gt;Methods. Multivariable logistic regression methods were used to analyze preoperative, perioperative, and postoperative risk factors for enlarged TEP in a 5-year retrospective cohort. %26lt;br%26gt;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. %26lt;br%26gt;Conclusion. Development of enlarged TEP is a multifactorial process related to both baseline and postoperative factors.

• 出版日期2012-4