Masashi Okazaki

Clinical Investigation of Surgical Closure of Tracheoesophageal Shunt

The purpose of this study was to elucidate the appropriate time for closing a tracheoesophageal shunt for a safe and non-invasive surgical procedure, after acquiring another type of vocal rehabilitation. A tracheoesophageal shunt is globally considered to be the most useful tool for excellent vocal rehabilitation; nevertheless, it must be closed for several reasons. In some cases, surgical closure of a tracheoesophageal shunt is difficult due to poor histological conditions around the shunt. We herein propose a new strategy of vocal rehabilitation to utilize a tracheoesophageal shunt effectively. Materials and methods: Between 1995 and 2014, 46 patients underwent voice prosthesis insertion surgery. Nine (eight laryngeal cancer patients, one thyroid cancer patient) of these patients underwent surgical closure of a tracheoesophageal shunt. We investigated their cancer treatments, reasons for closing the tracheoesophageal shunt, period of voice prosthesis insertion, operative method, number of operations, and outcome. Results: The reasons for closing the tracheoesophageal shunt were aspiration pneumonia and acquisition of esophageal voice in 4 patients each. Regarding the period of voice prosthesis speech, 6 patients had used it for approximately 3 years and 3 patients for more than 7 years. Approximately all 3-year users underwent a non-invasive surgical procedure, such as triple-layered suture, and their operation succeeded the first time. Conversely, the more than 7-year users required an invasive surgical procedure, such as a pedicle flap, and had to undergo more than one operation. Conclusion: In the present study, tracheoesophageal shunt closure could be performed within 3 years via a safe and non-invasive surgical procedure. We recommend that the operation for a tracheoesophageal shunt be undertaken at a relatively early stage after total laryngectomy. Such patients should acquire esophageal voice within 3 years and undergo surgical closure of the tracheoesophageal shunt as soon as possible.