Primary versus delayed tracheoesophageal puncture for laryngopharyngectomy with free flap reconstruction§

Authors

  • Catherine F. Sinclair MD,

    1. Department of Surgery, Medical Statistics Section, Biostatistics and Bioinformatics Unit, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Eben L. Rosenthal MD,

    1. Department of Surgery, Medical Statistics Section, Biostatistics and Bioinformatics Unit, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Nancy L. McColloch MS, CCC-SLP,

    1. Department of Surgery, Medical Statistics Section, Biostatistics and Bioinformatics Unit, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • J. Scott Magnuson MD,

    1. Department of Surgery, Medical Statistics Section, Biostatistics and Bioinformatics Unit, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Reneé A. Desmond DVM, PhD,

    1. Division of Otolaryngology—Head and Neck Surgery, and Department of Medicine, Medical Statistics Section, Biostatistics and Bioinformatics Unit, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Glenn E. Peters MD,

    1. Department of Surgery, Medical Statistics Section, Biostatistics and Bioinformatics Unit, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • William R. Carroll MD

    Corresponding author
    1. Department of Surgery, Medical Statistics Section, Biostatistics and Bioinformatics Unit, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
    • University of Alabama at Birmingham, BDB 563, 1530 3rd Ave. S., Birmingham, AL 35294-0012
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  • This study was presented as a poster at the 2011 Combined Sections Meeting January 27–29, 2011, at the Westin Kierland Resort, Scottsdale, AZ.

  • The authors have no financial disclosures for this article. The authors did not receive any funds in support of this study

  • §

    The author have no conflicts of interest to declare.

Abstract

Objectives:

To determine whether postoperative complication rates and speech outcomes differ between patients undergoing primary versus secondary tracheoesophageal puncture following total laryngectomy with free flap reconstruction.

Study Design:

Retrospective clinical study in a tertiary academic center.

Methods:

Between November 2004 and June 2010, 137 patients underwent total laryngectomy or laryngopharyngectomy with pharyngeal free flap reconstruction for malignant disease. Data was collected on patient and operative demographics, early postoperative complications, speech outcomes, and predictive factors for tracheoesophageal puncture failure.

Results:

Thirty patients (22%) had a primary tracheoesophageal puncture performed at the time of laryngectomy, 27 patients (20%) received secondary punctures (>3 months postlaryngectomy), and 80 patients (58%) never received a puncture. Patient and operative demographics were similar between groups (P < .05), apart from proportionately more hypopharyngeal tumors in the “no puncture” group (P < .002). Similar numbers of patients in primary and secondary puncture groups achieved intelligible speech (67% vs. 71%, P = .82) and both groups reported good patient-perceived voice-related quality of life. Salvage surgery and nonpatch radial forearm free flap reconstruction both trended toward increased early postoperative complication rates (P = .09).

Conclusions:

There is no difference in the early postoperative complication rate for primary versus secondary tracheoesophageal puncture following total laryngectomy with concurrent free flap reconstruction. Radial forearm patch free flap reconstruction achieves good speech outcomes.

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