Key Recommendations for Tracheoesophageal Puncture: Interview with Dr. Miguel Mayo-Yáñez
Regaining the ability to speak just weeks after a laryngectomy can make a difference in a patient’s recovery — emotionally, socially, and clinically. A new systematic review led by Dr. Miguel Mayo-Yáñez highlights the benefits of primary tracheoesophageal puncture (TEP) and offers evidence-based recommendations to guide surgical decision-making.
We spoke with Dr. Mayo-Yáñez about the most impactful findings, including when primary TEP is preferred, what factors influence success, and why clearer standards in reporting are urgently needed.
Dr. Miguel Mayo Yáñez, MD, PhD is an Otolaryngologist and Head and Neck Surgeon at the University Hospital in Coruña and is Head of Department at Hospital San Rafael in Spain. He has specialized in Oncologic Head and Neck Surgery, Endocrine Surgery, and Rhinology, and his doctoral studies focused on the rehabilitation of laryngectomized patients, aiming to improve their quality of life. Dr. Mayo is the author of over 100 scientific publications, and he collaborates with universities in Coruña and Santiago de Compostela, contributing to medical education and research.
What motivated you to carry out research in the field of laryngectomy?
Laryngectomy is a life-changing surgery, and as an ENT surgeon, I’ve always been deeply moved by the personal and functional impact it has on patients — particularly the challenge of voice rehabilitation. My motivation came from a desire to better understand what we do well, what we assume without strong evidence, and where we need to improve. Researching this field felt like a responsibility toward my patients, especially those who face communication as the central struggle after cancer treatment.
Based on your 2024 review of 91 articles on primary vs. secondary tracheoesophageal puncture, which recommendation could most impact clinical decision-making?
One of the most actionable findings is the strong support for primary TEP (tracheoesophageal puncture) in suitable candidates. The review confirms that it is a safe, quick and straightforward procedure, especially when performed by experienced surgeons within a multidisciplinary team.1
The role of speech-language pathologist is also emphasized — successful outcomes depend not only on the surgical technique but also on close collaboration with Speech Language Pathologist before and after surgery. In addition, the review reinforces that secondary TEP is a reliable and effective option when primary TEP is not feasible.1
What surprised you the most during the process of conducting this systematic review regarding the available evidence?
What surprised me most was the heterogeneity in definitions and outcome reporting, even across high-quality studies. Terms like “successful voice restoration,” “TEP-related complications,” or even “pharyngocutaneous fistula” were not uniformly defined. This makes comparison difficult and highlights the urgent need for standardized reporting criteria in future studies. Also, I was positively surprised by the number of robust retrospective cohorts available, which allowed us to draw meaningful conclusions even in the absence of randomized controlled trials.
What were the most compelling findings regarding patient outcomes, and how does this compare to secondary TEP?
Patients who undergo primary TEP typically regain verbal communication significantly earlier, which has a profound impact on psychosocial adjustment and quality of life. Many studies reported voice success rates above 85% in both primary and secondary TEP groups.1
Crucially, the review found no significant differences in terms of complication rates between primary and secondary TEP, when appropriate patient selection and surgical planning are in place. The main advantage of primary TEP lies in the timing: patients can start speaking weeks or even months earlier, which can make a major difference in emotional recovery. That said, both approaches are valid, and the best outcomes come from individualized treatment decisions.1
Looking ahead, what further research would you like to see to strengthen or expand upon the recommendations made in this review?
I would like to see more prospective multicenter studies that include standardized definitions and long-term follow-up of voice outcomes. Additionally, we need better integration of patient-reported outcome measures (PROMs) and quality-of-life assessments to capture what truly matters to patients. Finally, studies exploring the role of surgical technique variations, reconstruction methods, and perioperative protocols in TEP success would help refine our recommendations further.
Interested in learning more?
Download our Clinical Summary of the publication Evidence-Based Recommendations in Primary Tracheoesophageal Puncture for Voice Prosthesis Rehabilitation, by Mayo-Yáñez et al.
References
1. Mayo-Yáñez M, Klein-Rodríguez A, López-Eiroa A, Cabo-Varela I, Rivera-Rivera R, Parente-Arias P. Evidence-Based Recommendations in Primary Tracheoesophageal Puncture for Voice Prosthesis Rehabilitation. Healthcare (Basel). 2024;12(6)
