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Primary Surgery vs Salvage Surgery

Heather M. Starmer, MA; Stacey L. Ishman, MD; Paul W. Flint, MD; Nasir I. Bhatti, MD, MHS; Jeremy Richmon, MD; Wayne Koch, MD; Kimberly Webster, MA; Ralph Tufano, MD; Christine G. Gourin, MD

Arch Otolaryngol Head Neck Surg. 2009;135(11):1165-1169.

Objective  To assess the effect of primary treatment on tracheoesophageal voice prosthesis (TEP) complications.

Design  Retrospective cohort study.

Setting  The Johns Hopkins Medical Institutions, Baltimore, Maryland.

Patients  Patients who underwent total laryngectomy and TEP between January 1, 1998, and December 31, 2008, were divided into 3 subgroups according to primary treatment: surgery (n = 81), radiotherapy (n = 61), and chemoradiotherapy (n = 32).

Main Outcome Measures  Number of weeks before leakage through the TEP, occurrence of leakage around the TEP, TEP dislodgement, and size changes 6 months or longer after laryngectomy.

Results  A total of 174 patients met the study criteria. Of the 81 patients who underwent primary surgery, 81% (n = 66) underwent adjuvant therapy with postoperative radiotherapy or chemoradiotherapy. The incidence of leakage around the prosthesis, prosthesis dislodgement, and size changes 6 months or longer after laryngectomy were significantly higher for patients who required salvage total laryngectomy after chemoradiotherapy or radiotherapy (P < .05). In addition, significantly more patients who underwent salvage total laryngectomy required extended laryngectomy or free tissue reconstruction.

Conclusions  Voice prosthesis complications are more frequently encountered in those who require salvage laryngectomy. Understanding the potential for such complications reinforces the need for close communication and follow-up with these patients by the speech language pathologist.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland (Mss Starmer and Webster and Drs Ishman, Flint, Bhatti, Richmon, Koch, Tufano, and Gourin) and Oregon Health and Science University, Portland (Dr Flint).

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