Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis

Chakravarty, Patrick Daragh; McMurran, A E L; Banigo, Adonye; Shakeel, Muhammad; Ah‐See, Kim

doi:10.1017/s0022215117002390

Cited by 42 publications

(45 citation statements)

References 19 publications

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“…Countless clinical variables such as gastroesophageal reflux, ageing effect, adjuvant radiotherapy, or timing of surgery can influence the laryngectomee patient to failure of vocal rehabilitation treatment and, consequently, the quality of life (QoL) [ 7 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula’s Wellness

Cocuzza

Grillo

Ferlito

et al. 2020

IJERPH

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(1) Introduction: Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy is associated with relevant physical and psychological sequelae. Treatment through tracheo-esophageal speech, if promising, can lead to very variable outcomes. Not all laryngectomee patients with vocal prosthesis benefit from the same level of rehabilitation mainly due to the development of prosthetic or fistula related problems. The relating sequelae in some cases are even more decisive in the patient quality of life, having a higher impact than communicational or verbal skills. (2) Material and Methods: A retrospective study was conducted on 63 patients initially enrolled with a history of total laryngectomy and voice rehabilitation, treated at the University Hospital of Catania from 1 January 2010 to 31 December 2018. Quality of life (QoL) evaluation through validated self-administrated questionnaires was performed. (3) Results: The Voice-Related Quality of Life questionnaire revealed significantly better outcomes in both socio-emotional and functional domains of the tracheoesophageal patient group compared to the esophageal group (p = 0.01; p = 0.01, respectively), whereas in the Voice Handicap Index assessment, statistically significant scores were not achieved (p = 0.33). (4) Discussion: The significant differences reported through the V-RQOL and Voice Handicap Index scales in the presence of fistula related problems and device lifetime reduction when compared to the oesophageal speech group have demonstrated, as supported by the literature, a crucial role in the rehabilitative prognosis. (5) Conclusions: The criteria of low resistance to airflow, optimal tracheoesophageal retention, prolonged device life, simple patient maintenance, and comfortable outpatient surgery are the reference standard for obtaining good QoL results, especially over time. Furthermore, the correct phenotyping of the patient based on the main outcomes achieved at clinical follow-up guarantees the primary objective of the identification of a better quality of life.

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Section: Discussionmentioning

confidence: 99%

Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula’s Wellness

Cocuzza

Grillo

Ferlito

et al. 2020

IJERPH

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“…Furthermore, other factors have been found to increase the risk of fistulas among patients who undergo salvage laryngectomy, including age, comorbidities, nutritional status, tumor burden, comorbidities, pharyngeal closure, and concomitant procedures. 55-59…”

Section: Discussionmentioning

confidence: 99%

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta‐analysis

Cabrera

Jones

Parker

et al. 2020

Otolaryngol.--head neck surg.

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Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.

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“…[1][2][3] Voice rehabilitation is commonly achieved by esophageal speech, artificial larynx and tracheoesophageal voice restoration. [4][5][6][7][8][9][10] Tracheoesophageal speech is obtained by a one-way valved VP inserted in a surgical created TEP. 8,11 Fistula can be performed as a primary procedure at the time of TL/PL (primary TEP) or in a late stage (secondary TEP).…”

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confidence: 99%

“…8,11 Fistula can be performed as a primary procedure at the time of TL/PL (primary TEP) or in a late stage (secondary TEP). 7,12 Tracheoesophageal speech has become the method of choice for speech restoration in patients undergoing TL, providing longer phonation time, better intelligibility and fluency compared with esophageal speech or electronic larynx. 1-3, 6-10, 12,13 There is a wide range of reported results in literature, with successful voice restoration after TEP commonly ranging from 40 to 90%.…”

mentioning

confidence: 99%

“…1-3, 6-10, 12,13 There is a wide range of reported results in literature, with successful voice restoration after TEP commonly ranging from 40 to 90%. 2,7,9 Primary TEP achieves a success rate of 65 to 85% and secondary TEP of 69 to 83%. 14 Both primary and secondary TEP are safe and ABSTRACT Background: Tracheoesophageal puncture (TEP) with voice prosthesis (VP) placement is considered the standard for vocal rehabilitation after total laryngectomy (TL).…”

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confidence: 99%

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Voice rehabilitation with phonatory prosthesis after total laryngectomy and pharyngolaryngectomy: comparison of functional outcomes between primary and secondary puncture

Salvador

Guimarães

Monteiro

2020

Int J Otorhinolaryngol Head Neck Surg

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Background: Tracheoesophageal puncture (TEP) with voice prosthesis (VP) placement is considered the standard for vocal rehabilitation after total laryngectomy (TL). This study aimed to compare the success rate of primary and secondary TEP and to evaluate the impact of clinical factors on functional outcome.Methods: A retrospective medical chart review was conducted in patients who underwent TL or pharyngolaryngectomy (PLT) and TEP. Variables collected included age, gender, comorbidities, tumor location and stage, extension of surgical resection, reconstruction, neck dissection, radiation therapy, salvage surgery, device lifetime, postoperative complications and successful voice restoration.Results: A total of 186 patients were enrolled in this study, 164 patients (88.2%) underwent primary TEP and 22 (11.8%) secondary TEP. Successful voice rehabilitation was achieved in 76.9% of patients and there was no difference between primary and secondary TEP groups (76.2% vs. 81.8%, p=0.76). A poorer voice restoration outcome was found in patients who underwent radiation therapy (p=0.01) or salvage surgery (p=0.03). Adjuvant radiation was the only independent prognostic factor for functional success (OR=4.7, IC 95%= 1.4-15.9, p=0.04). VP related complications occurred in 65.7% of patients, with higher incidence in secondary TEP group (90.9% vs. 67.7%, p=0.03). Overall device lifetime was similar between primary and secondary groups (9.2 vs. 8.7 months, p=0.89).Conclusions: Voice rehabilitation outcome was similar with primary and secondary TEP. However, TEP related complications were more common in secondary procedures. Primary TEP allows earlier voice restoration, avoiding a second surgical intervention. Functional success rate was poorer for patients who underwent radiation therapy.

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Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis

Abstract: Primary tracheoesophageal puncture is a safe and efficient approach for voice rehabilitation. However, secondary tracheoesophageal puncture should be preferred where there is a higher risk of pharyngocutaneous fistula.

Cited by 42 publications

References 19 publications

Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula’s Wellness

Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula’s Wellness

Pectoralis Major Onlay vs Interpositional Reconstruction Fistulation After Salvage Total Laryngectomy: Systematic Review and Meta‐analysis

Voice rehabilitation with phonatory prosthesis after total laryngectomy and pharyngolaryngectomy: comparison of functional outcomes between primary and secondary puncture

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