Alessia Chini

Grazia Salerno

Luigi Sivero

Nicola Gennarelli

Saverio Siciliano

Serena Volpe

Stefania Sivero

English

Archivio della ricerca - Università degli studi di Napoli Federico II

Oncological and psychological evaluation of laryngectomized patients, pre and post implantation of voice prostheses.A single center experienceAnn Ital Chir, 2022 93, 6: 633-636pii: S0003469X22037551Online ahead of print 2022 - Feb. 28free reading: www.annitalchir.comPervenuto in Redazione Dicembre 2021. Accettato per la pubblicazioneGennaio 2022.Correspondence to: Luigi Sivero, Via Girolamo Cerbone 30, 80124Napoli (e-mail sivero@unina.it)Luigi Sivero*, Saverio Siciliano*, Alessia Chini*, Serena Volpe*, Nicola Gennarelli*, Grazia Salerno**, Stefania Sivero***Medical-Surgical Department of Diseases of the Digestive System, Federico II University of Naples, Naples, Italy**Head-Neck Department “Federico II” University Hospital of Naples, Naples, ItalyOncological and psychological evaluation of laryngectomized patients, pre and post implantation ofvoice prostheses. A single center experienceBACKGROUND: In our study we evaluated from an oncological and psychological point of view, a group of patients whohad previously undergone total laryngectomy and candidates for the placement of a vocal prosthesis, which allows torecover the voice using the air that passes from the trachea to the esophagus, thus vibrating a segment of the cervicalesophagus. For the placement of the prosthesis and the oncological follow-up, we used the support of videoendoscopy, toexclude any recurrence or secondary tumors. At the same time, we subjected patients to a psychological evaluation beforeand after the implantation of the prostheses, to understand the behavioral changes in the two phases, and the possibleachievement of the result of total autonomy, social reintegration, and recovery of oral communication, in the post-sur-gical phase.METHODS: We performed a complete esophagogastroduodenoscopy and psychological evaluation on 42 patients who hadpreviously undergone a total laryngectomy, before proceeding to the creation of a tracheoesophageal !stula and the place-ment of a phonatory prosthesis. After six months, we re-evaluated the same patients, both from an oncological and psy-chological point of view.RESULTS: At the preimplantation control of the prosthesis, in endoscopy we detected three neoplastic relapses that did notallow the placement of a prosthesis, and four patients who had grade B esophagitis according to the Los Angeles classi-!cation, in the remaining 35 patients there were no complications. At the psychological evaluation, most of the patientshad psychosocial disorders, with phenomena of anxiety and depression. At the check-up six months after implantation,none of the patients had relapses, and the voice prosthesis was not fully functional in a single patient. From a psycho-logical point of view, voice recovery has signi!cantly improved relationships both in the family and in the social sphere.CONCLUSIONS: Our experience has con!rmed the interesting and advantageous use of videoendoscopy in patients under-going total laryngectomy and candidates for the placement of a tracheoesophageal vocal prosthesis, in the evaluation ofneoplastic relapses and secondary lesions of the esophagus. "e role of the psychologist both in the pre and post prostheticphase is fundamental in assessing the discomfort of these patients by helping them solve some problems such as isolationand anxiety.KEY WORDS: Anxiety, Depression, Total laryngectomy, Voice prosthesisTotal laryngectomy, which is usually performed in asso-ciation with functional or destructive or bilateral deple-tion of the lymph nodes, involves, once the larynx isremoved, the need to reconstruct the pharyngo-esophageal continuity, and then to provide for a tra-cheotomy. !e immediate and most obvious consequenceof total laryngectomy is the loss of voice. Fortunately,it is possible to return the voice to the laryngectomiesby inserting a tracheoesophageal vocal prosthesis.IntroductionTotal laryngectomy involves the complete sacri"ce of theorgan and the execution of a permanent tracheostomy.Ann. Ital. Chir., 93, 6, 2022 - Feb. 28 - Online ahead of print 633READ-ONLY COPY PRINTING PROHIBITEDIn our study we analyzed the use of #exible videoen-doscopy in patients undergoing total laryngectomy, can-didates for the placement of the tracheo-esophageal vocalprosthesis, which is realized by creating a tracheo-esophageal "stula in which the prosthesis is positioned,which acts as a unidirectional valve, allowing the recov-ery of the voice. Fistula can also be created after a longtime after the operation, the technique has minimal mor-bidity and a high percentage of positive results. !e mostused prostheses are the so-called residential ones that arereplaced on average every 5-6 months.!e use of #exible video endoscopy in oncological fol-low-up carefully evaluates the hypopharyngeal-esophageal-gastric district for relapses or secondarytumors, which, according to a review of the literature,can develop in this district in more than 10% of patientsoperated on for laryngeal neoplasms. Endoscopy has the advantage of being able to assess thecompliance of the hypopharyngo-oesophageal segmentbefore the application of the prosthesis, excluding post-surgical scar stenosis or after radiotherapy, and to high-light lesions of the esophageal mucosa from gastroe-sophageal re#ux in patients with hiatal hernia and / orcardial incontinence. !e use of video endoscopy afterthe application of the prosthesis allows to evaluate thecorrect positioning and length of the prosthesis itself, theclosure or stenosis of the "stula due to malposition orextrusion of the prosthesis, to diagnose the cause of mal-function, due to the presence of mucous granulations,of variable prosthetic infusion, of bacterial colonizationof the valve mechanism, of physiological wear.In this study we did not neglect the evaluation of thepsychological aspects of laryngectomized patients, whoconsider the loss of the voice, due to the removal of thevocal cords, the central problem after surgery, togetherwith the fear of being alone and excluded from anysocial relationship. !e role of the psychologist for thesepatients appears fundamental, in fact he must be ableto make a psychosocial diagnosis and consider the riskof a post-surgical failure of adaptation. In addition, itmust include psychotherapy to reduce anxiety and pos-sible depression.Materials and MethodsIn the years 2019-2020 we followed 42 patients, 36males and 6 females, aged between 48 and 72 years,who underwent total laryngectomy. We performed acomplete esophagogastroduodenoscopy and psychologicalevaluation, on all patients, before proceeding to the cre-ation of a tracheoesophageal "stula and the placementof a vocal prosthesis. After six months, we re-evaluated the same patients, bothfrom an oncological and psychological point of view.Esophagogastroduodenoscopy was performed, using anOlympus video gastroscope, to exclude the presence ofpathologies that contraindicated the placement of theprosthesis. Provox2 or Bloom Singer vocal prostheses were appliedto selected patients undergoing tracheoesophageal "stu-la. In all prosthesis placement procedures, endoscopy hasbeen used to support the correct placement of the pros-thesis, opening and functioning. After total laryngecto-my and loss of voice and before implantation of theprosthesis, all patients were evaluated, regarding the psy-chological aspects of voice loss, with a psychologicalhealth questionnaire consisting of 26 closed-ended ques-tions on a Likert scale. !e main purpose of the ques-tionnaire was to understand if the patient, after surgerywith consequent loss of voice, had been able to relateto people, and how he evaluated the quality of his life.After six months, we re-evaluated the same patients, bothfrom an oncological and psychological point of view.ResultsAt the preimplantation endoscopic control of the pros-thesis, 3 patients who had a local recurrence or sec-ondary localization in the esophagus were excluded fromthe placement; in four patients it was not possible toproceed due to the presence of a hiatal hernia and / orcardiac incontinence with grade B esophagitis accordingto the Los Angeles classi"cation. In the remaining 35 patients, in whom there were nocomplications, 27 Provox2 prostheses and 8 BloomSinger prostheses were applied. At the psychological eval-uation, most of the patients had psychosocial disorders,with isolation even in the family environment, and phe-nomena of anxiety and depression. !e results obtainedcon"rmed a high percentage of patients, about 70%,who con"rmed a general discomfort, especially related tothe modi"cation of their body and the inability to com-municate with other people. At post-prosthetic endo-scopic control after 6 months, minor complications werefound, two patients presented an in#ammatory reactionat the site of the "stula, resolved with medical therapy,one patient had a progressive deterioration in speechfunction, which endoscopic control proved to be causedby too short prosthesis. !e psychological evaluation showed a clear improve-ment in psychological conditions, many patients saidthey imagined a future quality of life certainly betterthan that prior to the placement of the prosthesis. Voicerecovery has signi"cantly improved relationships both inthe family and in the social sphere.DiscussionVocal prostheses are certainly an important method toallow laryngectomized patients to improve their qualityof life, both for the physical and functional aspects (voiceL. Sivero, et al.634 Ann. Ital. Chir., 93, 6, 2022 - Feb. 28 - Online ahead of printREAD-ONLY COPY PRINTING PROHIBITEDrecovery), and for the psychological aspects (anxiety,depression). !e success of the method is linked to var-ious factors, such as the careful selection of patients,from the motivational point of view, and the oncologi-cal follow-up for the evaluation of the hypopharyngeal-esophageal-gastric district. For this last aspect we haveconsidered the use of #exible videoendoscopy, whichallows a better evaluation.ConclusionsOur experience has con"rmed the interesting and advan-tageous use of #exible esophagogastroduodenoscopy, inpatients undergoing total laryngectomy and candidatesfor the placement of a tracheo-esophageal vocal pros-thesis, in the evaluation of any relapses and secondaryneoplastic lesions of the esophagus. Fundamental is therole of pre- and post-prosthetic psychological evaluation,as it is able to make a psychosocial diagnosis, consider-ing the well-founded risk of poor post-surgical adapta-tion. In addition, the use of psychotherapy, in particu-lar cases, can decrease the incidence of anxiety and pos-sible depression. Surely the recovery of the voice withthe vocal prosthesis can return a better quality of life topatients.RiassuntoNel nostro studio abbiamo valutato da un punto di vistaoncologico e psicologico un gruppo di pazienti prece-dentemente sottoposti a laringectomia totale e candidatial posizionamento di una protesi fonatoria, che perme-tte di recuperare la voce utilizzando l’aria che passa dal-la trachea all’esofago, facendo vibrare un segmento del-l’esofago cervicale. Per il posizionamento della protesi eil follow-up oncologico, abbiamo utilizzato il supportodella videoendoscopia, per escludere eventuali recidive otumori secondari. Contestualmente, abbiamo sottopostoi pazienti ad una valutazione psicologica prima e dopol’impianto delle protesi, per comprendere i cambiamen-ti comportamentali nelle due fasi, e il possibile rag-giungimento del risultato di totale autonomia, reinseri-mento sociale e recupero della comunicazione orale, nel-la fase post-chirurgica.METODI. Abbiamo eseguito un’esofagogastroduodeno-scopia completa e una valutazione psicologica su 42 pazi-enti che erano stati precedentemente sottoposti alaringectomia totale, prima di procedere alla creazione diuna "stola tracheoesofagea e al posizionamento di unaprotesi fonatoria. Dopo sei mesi, abbiamo rivalutato glistessi pazienti, sia dal punto di vista oncologico che psi-cologico.RISULTATI. Al controllo preimpianto della protesi, inendoscopia abbiamo rilevato tre recidive neoplastiche chenon hanno consentito il posizionamento di una protesi,e quattro pazienti che presentavano esofagite di grado Bsecondo la classi"cazione di Los Angeles, nei restanti 35pazienti non si sono veri"cate complicanze. Alla valu-tazione psicologica la maggior parte dei pazienti presen-tava disturbi psicosociali, con fenomeni di ansia e depres-sione. Al controllo sei mesi dopo l’impianto, nessuno deipazienti ha avuto recidive e la protesi fonatoria non eracompletamente funzionante in un singolo paziente. Daun punto di vista psicologico, il recupero della voce hanotevolmente migliorato le relazioni sia in famiglia chenella sfera sociale.CONCLUSIONI. La nostra esperienza ha confermato l’in-teressante e vantaggioso utilizzo della videoendoscopia inpazienti sottoposti a laringectomia totale e candidati alposizionamento di una protesi fonatoria tracheoesofagea,nella valutazione delle recidive neoplastiche e delle lesionisecondarie dell’esofago. Il ruolo dello psicologo sia nel-la fase pre che post protesica è fondamentale nel val-utare il disagio di questi pazienti aiutandoli a risolverealcuni problemi come l’isolamento e l’ansia.References1. Brownle B, Ahmad S, Grammer T, Krempl G: selective patientexperience with the blom-singer dual valve voice prosthesis.Laryngoscope, 2017. 2. Arenaz Bua B, Olsson R, Westin U, Rydell R: "e pharyngoe-sophageal segment after total laryngectomy. Ann Otol Rhinol Laryngol,2017; 126(2):138-45. 3. Teng Zhang, Julia Maclean, Michal Szczesniak, Bertrand P,Harry Quon, Raymond K. Tsang, Peter I. Wu, Peter Graham, IanJ. Cook: esophageal dysmotility in patients following total laryngecto-my. Otolaryngol Head Neck Surg, 2017; 1:194. 4. Talpaert MJ, Balfour A, Stevens S, Baker M, Muhlschlegel FA,Gourlay CW, Pellicani AD, Ricz H, Iqueda AP, Aguiar-Ricz L:E#ect of the tracheoesophageal voice resistance test in total laryngec-tomees. Laryngoscope, 2017; 127(2). 5. Moira J. Talpaert, Balfour A, Stevens S, Baker M, Fritz A.Muhlschlegel, Campbell W, Gourlay: Candida bio!lm formation onvoiceprostheses. J Med Microbiol, 2015; 64(Pt 3):199-208. 6. Kouadio AA, Niagha G, N’Goran K, Le Bars P: Removable pros-thesis insertion steps: Controls-quali!cations. Odontostomatol Trop,2014; 37(145):13-26.  7. Lewin JS1, Portwood MA, Wang Y, Hutcheson K: Clinicalapplication of the Provox NiD voiceprosthesis: a longitudinal study.Laryngoscope, 2014; 124(7):1585-591. 8. Reis N, Aguiar-Ricz L, Dantas RO, Ricz HM: Correlation ofintraluminal esophageal pressure with the dynamic extension of tra-cheoesophageal voice in total laryngectomees. Acta Cir Bras, 2013;28(5):391-6. 9. D’Alatri L, Bussu F, Scarano E, Paludetti G, Marchese MR:Objective and subjective assessment of tracheoesophageal prosthesis voiceoutcome. J Voice, 2012; 26(5):607-613. 10. Takeshita TK, Zozolotto HC, Ricz H, Dabtas RO, Aguiar-RiczL: Correlation between tracheoesophageal voice and speech and intra-Ann. Ital. Chir., 93, 6, 2022 - Feb. 28 - Online ahead of print 635Oncological and psychological evaluation of laryngectomized patients, pre and post implantation of voice prostheses.READ-ONLY COPY PRINTING PROHIBITEDluminal pharyngoesophageal transition pressure. Pró-fono: Revista deAtualização Cientí"ca, 2010; 22(4):485-90. DOI:10.1590/S0104-5687201000040002111. Bickford J, Coveney J, Baker J, Hersh D: Living with thealterned self: A qualitive study of life after total laryngectomy.International Journal of Speech-Language Pathology, 2013; 15(3):324-333 12. Magnani M: Le problematiche psicologiche del laringectomizzato.I quaderni della salute, 2010; 1(1): 25-26 13. Sanchez RA, Collado JIA, Sebastian JM, Bondia A, Vallès H:Valoration del grado de afectacion sobre la salud psiquica en el pacienteprelaringectomizado. Acta Otorrinolaringologica Espanola, 2011;62(3): 220-22714. Sironi P: Gestione della “Qualità di vita” del paziente oncologicodella testa-collo. Corriere dei laringectomizzati, 2015; 44(1): 4-5 15. Spiegel D, Classen C: Terapia di gruppo per pazienti oncologici.Milano, McGraw-Hill, 2003L. Sivero, et al.636 Ann. Ital. Chir., 93, 6, 2022 - Feb. 28 - Online ahead of printREAD-ONLY COPY PRINTING PROHIBITED

Oncological and psychological evaluation of laryngectomized patients, pre and post implantation of voice prostheses. A single center experience

https://www.iris.unina.it/bitstream/11588/929907/1/Oncological%20and%20psychological%20evaluation%20voice%20prostheses_unlocked.pdf

Oncological and psychological evaluation of laryngectomized patients, pre and post implantation of voice prostheses. A single center experience

Abstract

Similar works

Full text

Available Versions

Archivio della ricerca - Università degli studi di Napoli Federico II