title: Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation.
abstract: OBJECTIVE
  To compare the rate of postoperative wound-healing complications and voice fluency in primary vs secondary tracheoesophageal puncture (TEP) following chemoradiation.
  
  
  METHODS
  Between 1998 and 2005, 30 patients underwent laryngectomy after chemoradiation therapy. Twenty patients underwent primary TEP and 10 patients underwent secondary TEP. Comorbidities, postoperative complications, speech fluency, and time to speech fluency were evaluated in each patient.
  
  
  RESULTS
  Pharyngocutaneous fistula (PCF) occurred in 10 of 20 (50%) patients who underwent primary TEP and in 0 of 10 (0%) patients in the secondary TEP group (P < 0.05). Overall, 25 of 25 (100%) patients who had placement of a tracheoesophageal prosthesis achieved fluent speech. Median time to fluency was 63 days in the primary TEP group and 125 days in the secondary TEP group.
  
  
  CONCLUSIONS
  There is an increased risk of PCF in patients undergoing primary TEP compared with secondary TEP following chemoradiation. No difference in acquisition of speech fluency was identified between the two groups. Patients undergoing primary TEP achieved fluent speech 62 days sooner than their secondary TEP counterparts.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Emerick
authors.forename: Luke
authors.initials: L
authors.lastname: Tomycz
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.forename: Teresa H
authors.initials: TH
authors.lastname: Lyden
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Teknos
mesh_terms: D003131:Combined Modality Therapy; D015897:Comorbidity; D017577:Cutaneous Fistula / Q000453:epidemiology / Q000209:etiology; D005402:Fistula / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D007831:Larynx, Artificial; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation; D010608:Pharyngeal Diseases / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D011677:Punctures; D016879:Salvage Therapy; D013065:Speech Intelligibility; D013071:Speech, Alaryngeal / Q000295:instrumentation; D016896:Treatment Outcome; D014945:Wound Healing