title: Enlarged tracheoesophageal puncture after total laryngectomy: a systematic review and meta-analysis.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hutcheson
authors.forename: Jan S
authors.initials: JS
authors.lastname: Lewin
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Asha
authors.initials: A
authors.lastname: Kapadia
authors.forename: Jan
authors.initials: J
authors.lastname: Risser
mesh_terms: D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000379:methods* / Q000534:rehabilitation; D007831:Larynx, Artificial; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation; D011677:Punctures / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D013071:Speech, Alaryngeal / Q000295:instrumentation / Q000379:methods*; D014132:Trachea / Q000601:surgery; D016896:Treatment Outcome; D014833:Voice Quality