title: Long-term functional speech and swallowing outcomes following pharyngolaryngectomy with free jejunal flap reconstruction.
abstract: Surgery for advanced cancer of the hypopharynx is a complex issue. Surgical intervention needs to take into consideration the resultant quality of life, in particular fundamental functional outcomes such as speech and swallowing. The aim of this study is to look at these long-term functional outcomes, following pharyngolaryngectomy and free jejunal reconstruction. A total of 19 patients, each undergoing a pharyngolaryngectomy with free jejunal graft was included. Each had a primary tracheoesophageal puncture for insertion of an indwelling voice prosthesis for speech. Functional outcomes of speech and swallow were assessed by a qualified speech pathologist. The impact on patients' quality of life was assessed under 4 domains: impairment, disability, handicap, and well being. The mean time period to follow-up was 4 years. Eighteen of the 19 patients were tolerating an oral diet, with one patient reliant on percutaneous endoscopic gastrostomy feeds. Seventeen patients (89%) were assessed as either having either no--or only a mild degree--of dysphagia, with no evidence of aspiration. Of the 19 patients, 15 were utilizing tracheosophageal speech for communication with 11 (73%) having no--or only a mild degree--of dsyphonia. Patients assessed as having no evidence of dysphagia or dysphonia also reported reduced levels of handicap and distress compared with patients experiencing any degree of dysphagia (P = 0.46) or dysphonia (P = 0.01). While rates of pharyngolaryngectomy increase, most patients have a poor long-term prognosis, heightening the significance of postoperative outcomes. The results of this study highlight the importance of speech and swallow outcomes, and demonstrate the direct correlation between these functions and resultant quality of life.
authors.affiliation: Department of Plastic Surgery, Princess Alexandra Hospital, Woollongabba, Brisbane, Queensland Australia. david_sharp@health.qld.gov.au
authors.forename: David A
authors.initials: DA
authors.lastname: Sharp
authors.forename: David R
authors.initials: DR
authors.lastname: Theile
authors.forename: Renee
authors.initials: R
authors.lastname: Cook
authors.forename: William B
authors.initials: WB
authors.lastname: Coman
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D013071:Speech, Alaryngeal; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome