Abstract
(1) Introduction: Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy is associated with relevant physical and psychological sequelae. Treatment through tracheo-esophageal speech, if promising, can lead to very variable outcomes. Not all laryngectomee patients with vocal prosthesis benefit from the same level of rehabilitation mainly due to the development of prosthetic or fistula related problems. The relating sequelae in some cases are even more decisive in the patient quality of life, having a higher impact than communicational or verbal skills. (2) Material and Methods: A retrospective study was conducted on 63 patients initially enrolled with a history of total laryngectomy and voice rehabilitation, treated at the University Hospital of Catania from 1 January 2010 to 31 December 2018. Quality of life (QoL) evaluation through validated self-administrated questionnaires was performed. (3) Results: The Voice-Related Quality of Life questionnaire revealed significantly better outcomes in both socio-emotional and functional domains of the tracheoesophageal patient group compared to the esophageal group (p = 0.01; p = 0.01, respectively), whereas in the Voice Handicap Index assessment, statistically significant scores were not achieved (p = 0.33). (4) Discussion: The significant differences reported through the V-RQOL and Voice Handicap Index scales in the presence of fistula related problems and device lifetime reduction when compared to the oesophageal speech group have demonstrated, as supported by the literature, a crucial role in the rehabilitative prognosis. (5) Conclusions: The criteria of low resistance to airflow, optimal tracheoesophageal retention, prolonged device life, simple patient maintenance, and comfortable outpatient surgery are the reference standard for obtaining good QoL results, especially over time. Furthermore, the correct phenotyping of the patient based on the main outcomes achieved at clinical follow-up guarantees the primary objective of the identification of a better quality of life.
Highlights
Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract, and accounts for about 177,000 new cases per year worldwide with an estimated 94,800 cancer deaths annually [1,2]
Among the various voice recovery solutions, the tracheo-esophageal puncture (TEP) with the insertion of voice prosthesis (VP) is the method generally recognized as a gold standard procedure for speech restoration after laryngectomy
39/54 (72.2%) who performed TEP rehabilitation were included, whereas 15/54 (27.8%) among the subjects rehabilitated with ES voice were selected
Summary
Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract, and accounts for about 177,000 new cases per year worldwide with an estimated 94,800 cancer deaths annually [1,2]. These patients who undergo head and neck surgery often experience challenges in communication, which may impact the quality of life (QoL) [2,3,4]. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy (TL) is associated with relevant physical and psychological sequelae, affecting essential life functions such as breathing, swallowing, and oral communication. Among the various voice recovery solutions, the tracheo-esophageal puncture (TEP) with the insertion of voice prosthesis (VP) is the method generally recognized as a gold standard procedure for speech restoration after laryngectomy
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