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. 2016 Dec;38(12):1765-1771.
doi: 10.1002/hed.24529. Epub 2016 Jul 9.

Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

Sarah A Gitomer  1   2 , Katherine A Hutcheson  1 , Brandon L Christianson  1 , Madeleine B Samuelson  1 , Denise A Barringer  1 , Dianna B Roberts  1 , Amy C Hessel  1 , Randal S Weber  1 , Jan S Lewin  1 , Mark E Zafereo  1   2
Affiliations

Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

Sarah A Gitomer et al. Head Neck. 2016 Dec.

Abstract

Background: We evaluated the impact of radiation, reconstruction, and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes.

Methods: Retrospective review identified 145 patients who underwent TEP between 2003 and 2007.

Results: Ninety-nine patients (68%) had primary and 46 (32%) had secondary TEP, with complications occurring in 65% and 61%, respectively (p = .96). Twenty-nine patients (20%) had major complications (18 primary and 11 secondary; p = .42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow-up, 82% primary and 85% secondary used TEP for primary communication (p = .66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% vs 50%; p = .02).

Conclusion: Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1765-1771, 2016.

Keywords: complications; speech outcomes; tracheoesophageal prosthesis; tracheoesophageal puncture (TEP).

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Figures

Figure I
Figure I
Relative complication rates based on timing of TEP and radiation (XRT) *No significant difference between complications in any group, all p > 0.05. **Major complications included spontaneous or intentional TEP closures, complications requiring surgical intervention, and pneumonia secondary to leakage ***Direct complications included enlarged TEP, aspiration of prosthesis, pneumonia secondary to leakage, spontaneous or intentional closure of TEP, partial TE tract closure, granulation tissue and superior tract migration.
Figure II
Figure II
Outcomes and complications in patients with free-flap reconstruction
See this image and copyright information in PMC

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