Early risk factors for enlargement of the tracheoesophageal puncture after total laryngectomy: nodal metastasis and extent of surgery.
OBJECTIVE
To determine the early risk factors for enlargement of the tracheoesophageal puncture (TEP) after total laryngectomy.


METHODS
Retrospective cohort study.


METHODS
The University of Texas MD Anderson Cancer Center, Houston.


METHODS
The study included 194 patients who underwent total laryngectomy (with or without pharyngectomy) and TEP (2003-2008).


METHODS
Multiple logistic regression methods were used to evaluate early risk factors for an enlarged TEP.


RESULTS
The incidence of an enlarged TEP was 18.6% (36 of 194 patients). After adjustment for follow-up time and radiotherapy history, patients with nodal metastases had a significantly higher risk of TEP enlargement (adjusted odds ratio, 6.6; 95% CI, 1.6-26.6) than those with node-negative disease. Total laryngopharyngectomy significantly increased the risk of an enlarged TEP (adjusted odds ratio, 4.5; 95% CI, 1.4-14.7) compared with simple total laryngectomy. Before multivariable adjustment, the preoperative body mass index was also significantly associated with enlargement (P for trend, .04).


CONCLUSIONS
These data suggest that 2 clinical factors-nodal staging and extent of resection-may help identify those at highest risk for TEP enlargement early after surgery. These simple indicators may ultimately aid in patient selection and prevention of an enlarged TEP after total laryngectomy.
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. karnold@mdanderson.org
Katherine A
KA
Hutcheson
Erich M
EM
Sturgis
Jan S
JS
Lewin
D000046:Academic Medical Centers; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D007831:Larynx, Artificial; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D011677:Punctures / Q000009:adverse effects; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013997:Time Factors; D016896:Treatment Outcome