Safety and Efficacy of Primary Tracheoesophageal Puncture and Prosthesis Fit

Abstract

Objectives: Compare the safety and efficacy of primary tracheoesophageal puncture (TEP) and prosthesis fit with traditional methods, such as secondary TEP or primary TEP with catheter stenting (secondary fit). Methods: Retrospective cohort study of patients who underwent total laryngectomy with TEP between 2009 and 2013. Voice outcome was assessed as voice production at the first postoperative appointment and TEP usage at 6 months and 1 year following puncture. Perioperative emergency department visits, pharyngocutaneous fistula (PCF), and stomal breakdown were analyzed. Results: Ninety patients were included. Seventy-three had primary TEPs, of which 32 were catheter stented and 41 were fitted primarily. The remainder (17) had secondary TEPs, of which 8 were primarily fit. Patients with primary fittings were less likely to come to the emergency department postoperatively (14% vs 39%, P < .01). PCF rate (9.3% vs 9.7%, P = .95) and stomal breakdown rate (12.2% vs 9.3%, P = .7) were similar between primary vs secondary fit. There was no difference in PCF or stomal breakdown rates between primary and secondary punctures. Among patients with primary punctures, primary fit patients trended toward higher initial voice success compared with secondary fit patients (87% vs 78%, P = .3). At 6 months and 12 months after surgery, primary fit patients also tended toward higher rates of TEP usage (6 m: 83% vs 61%, P = .1; 12 m: 92% vs 73%, P = .17). Conclusions: Primary TEP with primary fit represents a safe and effective approach to vocal rehabilitation following total laryngectomy.