Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation

Abstract

There is an increased risk of PCF in patients undergoing primary TEP compared with secondary TEP following chemoradiation. No difference in acquisition of speech fluency was identified between the two groups. Patients undergoing primary TEP achieved fluent speech 62 days sooner than their secondary TEP counterparts.

Comparison between Primary and Secondary Tracheoesophageal Puncture Prosthesis: A Systematic Review

“…Regarding this subject, 6 articles analyzed the TEP, and the incidence of fistulas was not configured as a risk factor ( p = 0.69 and I 2 = 86%). When studies that led to high heterogeneity were removed [13,15], we observed the same effect obtained above ( p = 0.48 and I 2 = 20; Fig. 6).…”

“…Furthermore, this is a complication easily resolved with no surgical intervention [14]. Emerick et al [13] found no difference in their series as regards infection among groups and this is very similar to data found by others [9,10,11], with slightly higher numbers of infection in the surgical wound in TEP1 when compared to TEP2, however, with no statistical significance. In contrast, Shenoy et al [12] found no occurrence of wound infection in their series.…”

“…Lacau St Guily et al [5] reported an increased risk of pharyngocutaneous fistula (PCF) in primary TEP compared to secondary TEP followed by chemoradiotherapy, though with no statistical significance in speech rehabilitation. Results found by other studies showed that complications of tracheostomy, dehiscence, stenosis and leakage around the prosthesis are uncommon, regardless of the type of puncture (primary or secondary [7,13,17]).…”

Insertion of a tracheoesophageal speech valve: a novel approach in a difficult situation

“…4,5 The advantages of tracheoesophageal speech valves over oesophageal speech include: immediate voice, high success rates and the ability to sustain speech with a more fluent quality than that achieved with oesophageal speech. 4,5 It is essential for the valve to have a good fit as this ensures both a water-and air-tight seal, thereby maximising voice quality and reducing the risk of aspiration and valve displacement. Leakage, both through the centre of the valve and around the periphery, is a common problem, occurring in up to 27 per cent of patients.…”

Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy

“…1 Primary TEP with intraoperative prosthesis placement has been associated with earlier voice acquisition, is safe and has higher rates of successful voice rehabilitation as compared to secondary TEP. 2,[3][4] Successful voice outcomes have also been reported in primary TEP with laryngopharyngectomy that require advanced reconstruction techniques, such as free tissue transfer. 4,5 The supraclavicular artery island flap (SCAIF) is an effective alternative to free tissue transfer and is being used with increasing frequency after laryngectomy.…”