title: Multivariable analysis of risk factors for enlargement of the tracheoesophageal puncture after total laryngectomy.
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.
  
  
  CONCLUSIONS
  Development of enlarged TEP is a multifactorial process related to both baseline and postoperative factors.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, 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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007825:Laryngectomy / Q000379:methods* / Q000534:rehabilitation; D007831:Larynx, Artificial; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010611:Pharyngectomy / Q000379:methods / Q000534:rehabilitation; D011183:Postoperative Complications / Q000503:physiopathology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods; D011677:Punctures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013071:Speech, Alaryngeal / Q000295:instrumentation* / Q000379:methods; D014132:Trachea / Q000601:surgery