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Head Neck. 2011 Jan;33(1):20-30. doi: 10.1002/hed.21399.

Enlarged tracheoesophageal puncture after total laryngectomy: a systematic review and meta-analysis.

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1
Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.

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.

CONCLUSION:

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.

PMID:
20848420
PMCID:
PMC4111130
DOI:
10.1002/hed.21399
[Indexed for MEDLINE]
Free PMC Article
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