Pearson near-total laryngectomy: a reproducible speaking shunt

Since 1980, Pearson and his associates at the Mayo Clinic have accrued an increasing number of patients whom they have treated with what is now designated as a "near-total" laryngectomy rather than a total laryngectomy. Despite the positive reports of the value of this procedure in providing speech by an internal shunt, the use of this total laryngectomy alternative has not gained wide acceptance. We report our experience with treating 11 patients during a 3-year period using the near-total laryngectomy.

Between September 1989 and September 1992, 11 patients with the following anatomic lesions were offered and accepted the option of the near-total laryngectomy: (1) T3 or early T4 glottic squamous cell carcinoma that did not involve the interarytenoid space or the vocal process of the opposite arytenoid; (2) T3 supraglottic squamous cell carcinoma with a fixed vocal cord in which a supraglottic laryngectomy could not be performed; (3) T2, T3 pyriform sinus squamous cell carcinomas; (4) radiotherapy failure early glottic lesions in which a vertical hemilaryngectomy for salvage was not able to be performed and met the requirements in (1); and (5) large hypopharyngeal lesions in which the larynx would be sacrificed to prevent aspiration but was not involved with tumor.

Nine of 11 patients (82%) attained successful speech in an average of 5.3 months. Two of the 11 patients required a completion laryngectomy, both due to wound complications. All but two of the patients received postoperative radiotherapy. Of the nine successful speakers, five have had an occasional droplet of fluid through the shunt; three have been on a permanent basis and two transient. Eighty-nine percent of the speaking patients (8 of 9) are alive without disease, a mean of 25.5 months after therapy completion.

The near-total laryngectomy can be performed outside the Mayo Clinic with creditable results, with 82% of the patients attaining successful speech, an average of 5.3 months postoperatively. Eighty-nine percent of the speakers have had a mean disease-free survival of 25.5 months. Analysis of larger series from multiple institutions in conjunction with voice analyses of these patients compared to those with tracheoesophageal punctures is needed to confirm our initial enthusiasm for this procedure.