Early Risk Factors for Enlargement of the Tracheoesophageal Puncture After Total Laryngectomy

Hutcheson, Katherine A.; Lewin, Jan S.

doi:10.1001/archoto.2012.1753

“…Likewise, the extent of surgery was not statistically predictive of device life. We agree that radiotherapy and extent of surgery are important factors that influence the success of TE voice restoration and postlaryngectomy functioning and have been described robustly in areas related to TE voice quality, swallowing, and postlaryngectomy complication . However, neither radiation nor extent of surgery showed any meaningful difference in device life in this study.…”

Section: Discussionsupporting

confidence: 70%

Device Life of the Tracheoesophageal Voice Prosthesis Revisited

Lewin

¹

,

Baumgart

²

,

Barrow

³

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Importance-Voice prosthesis (VP) device life is a limiting factor of tracheoesophageal (TE) voice restoration that drives patient satisfaction, health care costs, and overall burden. Historic data suggest that TE VPs have an average device life of generally 3 to 6 months, but these data are typically derived from small samples using only 1 or 2 devices.Objective-To reexamine current device life in a large, contemporary cancer hospital in the United States that uses a wide assortment of VPs. Main Outcomes and Measures-Tracheoesophageal voice-related outcomes were: (1) device life duration to VP removal, and (2) treatment-related and prosthetic-related factors influencing device failure. Primary independent variables included treatment history (extent of surgery and radiation history), VP type (indwelling vs nonindwelling, size, specialty features), and reason for removal (leakage, complication, other). Duration was examined using Kaplan-Meier analysis. Disease, treatment, and patient-specific factors were analyzed as predictors of duration.Results-Overall, 3648 VPs were placed in the 390 patients (median [range] age, 62 [34-92] years). Indwelling prostheses accounted for more than half (56%) of the devices placed (55%, 20-Fr diameter; 33%, 8-mm length). More than two-thirds (69%) of prostheses were removed because of leakage, while the rest were removed for other reasons. Median device life was 61 days for all prostheses. Indwelling and nonindwelling VPs had median device lives of 70 and 38 days, respectively. There was no significant difference between specialty prostheses compared with standard devices (median duration, 61 vs 70 days, respectively). The Provox ActiValve (Atos HHS Public AccessAuthor manuscript JAMA Otolaryngol Head Neck Surg. Author manuscript; available in PMC 2018 January 01. Conclusions and Relevance-Our data suggest that VP duration demonstrates a lower durability than historically reported. This may reflect the intensification of treatment regimens that complicate TEP management in an era of organ preservation; however, further investigation is needed.

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“…We agree that radiotherapy and extent of surgery are important factors that influence the success of TE voice restoration and postlaryngectomy functioning and have been described robustly in areas related to TE voice quality, swallowing, and postlaryngectomy complication. [12][13][14] However, neither radiation nor extent of surgery showed any meaningful difference in device life in this study.…”

Section: Discussioncontrasting

confidence: 69%

Device Life of the Tracheoesophageal Voice Prosthesis Revisited

Lewin

¹

,

Barrow

²

,

Barringer

³

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Importance-Voice prosthesis (VP) device life is a limiting factor of tracheoesophageal (TE) voice restoration that drives patient satisfaction, health care costs, and overall burden. Historic data suggest that TE VPs have an average device life of generally 3 to 6 months, but these data are typically derived from small samples using only 1 or 2 devices.Objective-To reexamine current device life in a large, contemporary cancer hospital in the United States that uses a wide assortment of VPs. Main Outcomes and Measures-Tracheoesophageal voice-related outcomes were: (1) device life duration to VP removal, and (2) treatment-related and prosthetic-related factors influencing device failure. Primary independent variables included treatment history (extent of surgery and radiation history), VP type (indwelling vs nonindwelling, size, specialty features), and reason for removal (leakage, complication, other). Duration was examined using Kaplan-Meier analysis. Disease, treatment, and patient-specific factors were analyzed as predictors of duration.Results-Overall, 3648 VPs were placed in the 390 patients (median [range] age, 62 [34-92] years). Indwelling prostheses accounted for more than half (56%) of the devices placed (55%, 20-Fr diameter; 33%, 8-mm length). More than two-thirds (69%) of prostheses were removed because of leakage, while the rest were removed for other reasons. Median device life was 61 days for all prostheses. Indwelling and nonindwelling VPs had median device lives of 70 and 38 days, respectively. There was no significant difference between specialty prostheses compared with standard devices (median duration, 61 vs 70 days, respectively). The Provox ActiValve (Atos HHS Public AccessAuthor manuscript JAMA Otolaryngol Head Neck Surg. Author manuscript; available in PMC 2018 January 01. Conclusions and Relevance-Our data suggest that VP duration demonstrates a lower durability than historically reported. This may reflect the intensification of treatment regimens that complicate TEP management in an era of organ preservation; however, further investigation is needed.

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“…Few studies have looked at comorbidities as a risk factor for TEP com plication. Hutcheson et al 20 included Adult Comorbidity Evaluation-27 score, diabetes, TSH, albumin, alcohol use, and smoking status in their analysis of risk factors associ ated with TEP enlargement, but found that none of these factors were associated with this particular complication. Mehle et al 21 reviewed 146 secondary TEP procedures and found no increased risk of complication associated with alcoholism, diabetes, or COPD.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Factors Impacting Long-Term Utilization of Tracheoesophageal Speech Among Laryngectomees

Boyd

¹

,

Houghton

²

,

Harrold

³

et al. 2020

Ann Otol Rhinol Laryngol

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Objective(s): To evaluate complication rate and abandonment rate after tracheoesophageal puncture and to assess factors associated with these outcome measures. Methods: Retrospective review of laryngectomy patients seen at a single academic institution between 1/1/2003 and 12/1/2018. Charts reviewed for demographics, medical comorbidities, tumor characteristics, surgical data, adjuvant treatment history, and complications related to laryngectomy or tracheoesophageal puncture. Complications were divided into minor and major. Results: A total of 293 laryngectomees met inclusion criteria. Of these, 69 patients (23.5%) underwent tracheoesophageal puncture. Average follow up was 64.6 months (SD 58.3). Overall laryngectomy complication rate was 43.3%. Overall tracheoesophageal puncture complication rate was 73.9%, with 39.1% of patients having major complications and 34.8% having minor complications only. Total abandonment rate for tracheoesophageal puncture was 34.8%. No associations were seen between tracheoesophageal puncture complication or abandonment rates based on age, gender, race, or insurance status. An increased rate of laryngectomy complications was seen after primary tracheoesophageal puncture (76.5% vs 41.3%, P = .005). Conclusion: Tracheoesophageal puncture outcomes were similar in patients with varied demographic, medical, and treatment backgrounds. When considering timing, our findings suggest that patients should be counseled on the possibility of increased complication risk after primary tracheoesophageal puncture. In those in whom the surgeon already has concerns about wound healing, it may be prudent to avoid primary tracheoesophageal puncture. The relatively high abandonment rate emphasizes the value of this measure of tracheoesophageal puncture outcome and highlights the need for appropriate patient counseling and prospective studies assessing the decision to abandon.

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Early Risk Factors for Enlargement of the Tracheoesophageal Puncture After Total Laryngectomy

Cited by 12 publications

References 15 publications

Device Life of the Tracheoesophageal Voice Prosthesis Revisited

Device Life of the Tracheoesophageal Voice Prosthesis Revisited

Device Life of the Tracheoesophageal Voice Prosthesis Revisited

Assessment of Factors Impacting Long-Term Utilization of Tracheoesophageal Speech Among Laryngectomees

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