Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis.


Journal

The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378

Informations de publication

Date de publication:
12 2020
Historique:
received: 06 08 2019
revised: 18 12 2019
accepted: 02 01 2020
pubmed: 7 2 2020
medline: 14 1 2021
entrez: 7 2 2020
Statut: ppublish

Résumé

To evaluate the demographics, clinical features, management, and prognostic indicators of tracheoesophageal puncture complications in patients undergoing placement of voice prosthesis following cancer treatment. Retrospective analysis. A retrospective analysis was conducted of cases from a tertiary referral center diagnosed between 1996 and 2015. Multivariate logistic regression was used to determine factors associated with tracheoesophageal puncture (TEP) and voice prostheses-complication-free survival (TEP/VP-CFS). One hundred fourteen cases were identified. Most patients were males (92.9%) with pT3 (26.8%) or pT4 (58.1%) N+ (53.6%) tumors. All patients received laryngectomy as the primary treatment, with 75% of patients receiving adjuvant radiation therapy or chemoradiotherapy. Complications with TEP were common (65.2%). The most frequent problem was salivary leakage (50.0%), which at the same time was the most common reason for changing the prosthesis. On univariate regression analysis, prosthesis placement time after adjuvant radiotherapy (hazard ratio [HR]: 4.17, 95% confidence interval [CI]: 2-8.69), secondary prosthesis placement after primary surgery (HR: 3.97, 95% CI: 1.99-7.9), and laryngectomy with flap reconstruction (HR: 1.96, 95% CI: 0.99-3.89) were significant prognosticators for complications. Multivariate regression analysis revealed secondary prosthesis placement after adjuvant radiotherapy (HR: 3.66, 95% CI: 1.39-9.68) or after primary surgery (HR: 2.57, 95% CI: 0.92-7.2) to be the strongest predictors of reduced TEP/VP-CFS. Secondary prosthesis placement after primary surgery, placement after previous irradiation, and laryngectomy with flap reconstruction are predictors of poor TEP/VP-CFS. Planned adjuvant radiotherapy is not a contraindication for TEP with prosthetic placement, but it is very important to place the prosthesis during the primary surgery or at least before scheduled radiotherapy. 4 Laryngoscope, 2020.

Identifiants

pubmed: 32027385
doi: 10.1002/lary.28517
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

E865-E873

Informations de copyright

© 2020 The Authors. The Laryngoscope published by Wiley Periodicals, Inc. on behalf of The American Laryngological, Rhinological and Otological Society, Inc.

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Auteurs

Claudia Scherl (C)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Julia Kauffels (J)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Anne Schützenberger (A)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Michael Döllinger (M)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Christopher Bohr (C)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Stephan Dürr (S)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Rainer Fietkau (R)

Department of Radiation Oncology, University of Erlangen, Nuremberg, Germany.

Marlen Haderlein (M)

Department of Radiation Oncology, University of Erlangen, Nuremberg, Germany.

Michael Koch (M)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Maximilian Traxdorf (M)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Konstantinos Mantsopoulos (K)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Sarina Müller (S)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

Heinrich Iro (H)

Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen, Nuremberg, Germany.

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