Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

Background: We evaluated the impact of radiation, reconstruction, and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes. Methods: Retrospective review identified 145 patients who underwent TEP between 2003 and 2007. Results: 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). Conclusion: 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.