Primary tracheoesophageal puncture in salvage laryngectomy patients.

OBJECTIVES/HYPOTHESIS The purpose of this study was to determine the rate of complications in the immediate postoperative period following primary tracheoesophageal puncture (TEP) after salvage laryngectomy. STUDY DESIGN Retrospective. METHODS A retrospective review was done of 26 patients who underwent primary TEP with salvage total laryngectomy. To minimize variables, the patients included were operated on by a single surgeon and rehabilitated by a single speech-language pathologist. The outcomes evaluated were the frequency of leakage around the TEP, dehiscence of the stoma, dislodging of the prosthesis, pharyngocutaneous fistula, time to initiation of oral intake, and length of hospital stay. RESULTS The mean age of the patients was 60.8 years (range, 41-78 years). Previous treatment consisted of radiotherapy in 14 patients and chemotherapy and radiation in 12. Tumor site was glottic in 12 patients, supraglottic in seven, subglottic in two, vallecula in three, and overlapping in two. The pharynx was repaired primarily in all patients and then reinforced with a pectoralis muscle flap in 13. Leakage around the TEP was observed in 4% of the cases. There were no instances of dislodging of the TEP, and six patients (23%) developed pharyngocutaneous fistula; 12% had a wound dehiscence but none were around the stoma. The average time to begin oral feeding was 5.7 days (standard deviation, 1.93), and the average hospital stay was 8.4 days (standard deviation, 1.93). CONCLUSIONS Primary TEP in the setting of a salvage laryngectomy is associated with a low rate of complications. A pharyngocutaneous fistula occurred in 23% of the cases. LEVEL OF EVIDENCE 4.