title: Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture.
abstract: We evaluated the impact of radiation, reconstruction, and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes.
  
  
  
  Retrospective review identified 145 patients who underwent TEP between 2003 and 2007.
  
  
  
  Ninety-nine patients (68%) had primary and 46 (32%) had secondary TEP, with complications occurring in 65% and 61%, respectively (p = .96). Twenty-nine patients (20%) had major complications (18 primary and 11 secondary; p = .42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow-up, 82% primary and 85% secondary used TEP for primary communication (p = .66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% vs 50%; p = .02).
  
  
  
  Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1765-1771, 2016.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Gitomer
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hutcheson
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Brandon L
authors.initials: BL
authors.lastname: Christianson
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Madeleine B
authors.initials: MB
authors.lastname: Samuelson
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Barringer
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Dianna B
authors.initials: DB
authors.lastname: Roberts
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Hessel
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Lewin
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Zafereo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004947:Esophagus / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013065:Speech Intelligibility; D013071:Speech, Alaryngeal / Q000379:methods*; D013997:Time Factors; D014132:Trachea / Q000601:surgery; D016896:Treatment Outcome
keywords: complications; speech outcomes; tracheoesophageal prosthesis; tracheoesophageal puncture (TEP)