Klaske van Sluis

52 3.3. Results Reconstruction (Primary closure vs. Major reconstruction) on the other hand. 3.3 Results 3.3.1 Study sample Inclusion, follow-up, and availability of data at the assessments are shown in the flow chart in Figure 1. Over all sites there was a total of 72 possible can- didates who underwent total laryngectomy in the study time frame, of whom 43 were included in the study. Thirty-four from the Netherlands, nine from the Australian sites. Reasons for exclusion were: decline to participate (n=8), live out of area (n=7), missed by the clinician (n=11), total laryngectomy in com- bination with total glossectomy (n=1), no medical information and follow-up assessments available (n=2). Patient characteristics are shown in Table 2. The majority of the included participants were male (n=33;77%), mean age was 64 years old at time of surgery (range 43-84). For 19 participants (44%) the total laryngectomy was the primary surgical treatment, in 24 cases 56% total laryngectomy was a sal- vage treatment. In 16 participants (37%) of the cases primary closure of the neopharynx was performed, major reconstruction was needed in 27 (63%) of the cases. The Australian patients (n=9) did not differ substantially from the Dutch. Within the Australian group all patients were male, for 33% (n=3) total laryngectomy was the primary treatment, 78% (n=7) had a major reconstruc- tion of the neopharynx. Before surgery 16 participants (37%) had a tracheostomy, which influences their communicative abilities. Although a high number of participants received a voice prosthesis, satisfactory voice rehabilitation with tracheoesophageal speech was not accomplished in all cases. Methods of communication are tabulated in Table 3. In total, 93% of the participants received a voice prosthesis, 79% (n=34) received primary puncture, 14% (n=6) secondary puncture. Seven per- cent (n=3) did not receive a voice prosthesis. Verbal communication with tra- cheoesophageal speech was documented in 17 out of 27 participants at T1, 22 out of 25 participants at T2, and 20 out of 22 participants T3. Of the total group, 30% (n=13) died within the first year after surgery and were excluded from the analysis. Two thirds of this group (n=9) did not achieve tracheoesophageal speech, they had to depend on augmentative alternative communication. Most of this group (n=7) did receive a voice prosthesis but could not use this due to postoperative complications such fistulas, only two participants in this group did not receive a voice prosthesis due to medical issues.