Functional utility and oncologic safety of near-total laryngectomy with tracheopharyngeal speech shunt in a Third World oncologic center.

This prospective study analyzes the feasibility, oncologic safety and functional utility of Pearson's near-total laryngectomy with tracheopharyngeal shunt (NTL-TPSS). The procedure was found to give gratifying locoregional control in 30 consecutive advanced T3 and selected T4 tumors involving the larynx (n = 11) and hypopharynx (n = 19) and managed at Kidwai Memorial Institute of Oncology, Bangalore, India. The oncologic "safety" of this technique was established in following examinations, ranging from 18 to 44 months (median, 22.2 months). A locoregional control rate of 74% was obtained. Lung-powered "shunt" speech was acquired with ease in periods ranging from 7 days in speakers deemed "excellent" (15/29) to 20 days in those deemed "satisfactory" (8/29). Except for a single case experiencing temporary aspiration of liquids, patients did not have any swallowing difficulties following removal of nasogastric tubes. The period of hospitalization averaged 22.6 days. The complication rate was 33%, with one patient death (3.3%) occurring. The dynamics of the TPSS were analyzed in selected "speakers" and "non-speakers", using transcutaneous needle electromyography. Analysis of data supports the possibility of dynamic speech modulation. However, the favored anatomic location and design renders the shunts aspiration-proof rather than demonstrating any active sphincteric action.