ENLARGED TRACHEOESOPHAGEAL PUNCTURE AFTER TOTAL LARYNGECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

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. (C) 2010 Wiley Periodicals, Inc. Head Neck 33: 20-30, 2011