title: Outcomes and adverse events of enlarged tracheoesophageal puncture after total laryngectomy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas, M D Anderson Cancer Center, Houston, Texas 77030, USA. karnold@mdanderson.org
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: Jan
authors.initials: J
authors.lastname: Risser
mesh_terms: D015331:Cohort Studies; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D007831:Larynx, Artificial; D008297:Male; D011015:Pneumonia, Aspiration / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D011677:Punctures / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014132:Trachea / Q000601:surgery; D016896:Treatment Outcome