title: Risk factors for tracheal necrosis after total pharyngolaryngectomy.
abstract: BACKGROUND
  Tracheal necrosis is a severe complication of total pharyngolaryngectomy (TPL). The purpose of this retrospective study was to identify risk factors for tracheal necrosis after TPL.
  
  
  METHODS
  We performed a retrospective chart review of 177 patients who had undergone TPL. The preoperative, operative, and postoperative variables were examined, and possible risk factors for tracheal necrosis were subjected to univariate analysis and multivariate logistic regression.
  
  
  RESULTS
  Tracheal necrosis occurred in 35 patients (19.8%), and tracheoesophageal fistula subsequently developed in 3 of these patients. Multivariate logistic regression analysis identified total esophagectomy and diabetes mellitus as significant risk factors for tracheal necrosis after TPL.
  
  
  CONCLUSIONS
  The findings of this study will be useful for assessing the risk of tracheal necrosis after TPL. In patients at high risk for tracheal necrosis, efforts should be made to preserve the tracheal circulation and to prevent life-threatening sequelae if tracheal necrosis occurs.
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Fujiki
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuraba
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Nagamatsu
authors.affiliation: Division of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002173:Cancer Care Facilities; D048909:Diabetes Complications / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D010611:Pharyngectomy / Q000009:adverse effects; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D014138:Tracheoesophageal Fistula / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome
keywords: esophageal cancer; free jejunal transfer; hypopharyngeal cancer; total pharyngolaryngectomy; tracheal necrosis