The current study retro specti vely review ed the cases of 68 patient s who had undergone total laryn gectomy and tracheoesophageal pun cture (TEP) ove r a lo-year period. Fifty-one patients under went p rimary TEP and i 7 underw ent seconda ry TEP. Nearly 80% of pati ents who received TEP at the time of laryngectomy achieved excellent voice quality perceptu ally. in contrast, only 50% of secondary TEP patients achieved excellent voice ratings. This diff erence was statistically robust (p = 0.03). A lthough both surgical and prosthesis-related comp lications occurred more fre quently fo llo wing prim ary TEp, statistically significant differences were not achieved. Neith er pre-nor p ostoperati ve radi oth erapy had any effe ct on voice restoration or complication rates. Based on thes e data, p rimary TEP may be pref erable fo r several reasons, ineluding a greater likelihood ofsuccessful voice restorati on, a sho rter duration ofpostoperat ive aphonia, and the elimination ofthe needf or a second opera tion and interim tube f eedin gs.