{Reference Type}: Journal Article
{Title}: The Localisation of a Tracheoesophageal Shunt during Laryn(-gopharyn)gectomy Determines the Risk of Shunt Insufficiency.
{Author}: Johnson F;Knopf A;
{Journal}: J Clin Med
{Volume}: 12
{Issue}: 24
{Year}: 2023 Dec 11
{Factor}: 4.964
{DOI}: 10.3390/jcm12247628
{Abstract}: <B>BACKGROUND: </B>Tracheoesophageal shunt insufficiency (TESI) is a common and potentially life-threatening complication after laryn(-gopharyn)gectomy (L(P)E). We investigated whether TESI could be the result of a specific shunt location.<BR><B>METHODS: </B>A monocentric, retrospective cohort analysis of 171 consecutively treated L(P)E patients was performed. Patients with a secondary prosthesis instillation and patients with insufficient postoperative imaging were excluded. Disease related data as well as location of primary voice prosthesis were assessed.<BR><B>RESULTS: </B>The cohort was divided into 62 TESI-positive and 109 TESI-negative individuals. The mean time from surgery to TESI was 32 months. No differences were observed in gender, age, tumor localization, T/R/M-status. Surgery without adjuvant therapy was more often performed in TESI-negative individuals when compared with their positive counterparts. However, Cox regression including T/N status, therapy and categorized distance of the tracheoesophageal shunt to the manubrium (≤1.5 cm vs. >1.5 cm) revealed that a distance of ≤1.5 cm was associated with a 2.1-fold increased risk of TESI, while all other parameters did not influence the event-free survival.<BR><B>CONCLUSIONS: </B>Primary shunt positioning ≤1.5 cm to the ridge of the manubrium is associated with an increased risk of TESI. In these individuals secondary shunt operation resulting in a position >1.5 cm distant to the manubrium should be recommended.