A 10-year experience with the Amatsu tracheoesophageal shunt

Abstract

Introduction: Tracheoesophageal shunt as described by Amatsu has been performed in our care center in total laryngectomy candidates since 1991. The goal is to offer patients better speech rehabilitation then that obtained with non-surgical techniques, and consequently lessens the impact of cancer treatment on patient's quality of life. This study reviews the 10-year experience of our institution with this procedure. Study design: Clinical retrospective. Material and method: Fifty-four (54) patients have undergone the procedure, three (3) female and fifty-one 51 males, from 30 to 78 years old (mean age of 59). All patients had squamous cell carcinoma as follows: ten (10) in the pyriform sinus, two (2) in the retrocricoid area, six (6) in the supraglottis, one (1) in the subglottis, sixteen (16) in the glottis and nineteen (19) were transglottic. According to AJCC staging system we had three (3) stage II, seventeen (17) stage III, twenty-four (24) stage IV and ten (10) cases were not staged. Previous radiotherapy as initial treatment was administered to eighteen (18) patients. During laryngectomy, thirty-three (33) patients had some type of neck dissection and the procedure was performed bilaterally in fifteen (15) of these patients. Five(5) patients needed myocutaneous pectoralis major flap and one (1) needed a deltopectoralis. Postoperative radiotherapy was used in 20 patients. Local infections occurred in 36% of the cases, and all had good outcome. One patient died in the early postoperative period. Results: Speech rehabilitation was successful in 70% of the cases with this technique. Aspiration occurred in ten (10) patients and the shunt had to be surgically closed in two (2) of these patients. Conclusion: In conclusion, due to its low cost, good results with few complications, the Amatsu tracheoesophageal shunt is still used in our service as the main technique for speech rehabilitation after laryngectomy.