264 Cardiopulmonary exercise testing in the laryngectomised patient: An anatomical challenge

Abstract

Introduction Laryngeal cancer, the second most common form of head and neck cancer within the UK [1] is often treated with a laryngectomy. A significant proportion of these patients will go on to develop further pulmonary primaries within 5 years, possibly amenable to further surgical intervention [2]. Cardiopulmonary exercise testing (CPEX) is a crucial pre-operative assessment tool used to determine a patient's fitness for surgery. It traditionally relies on a closed circuit, utilising a mouth-piece interface connected to a CPEX flow sensor. The altered anatomy of a laryngectomised patient inevitably changes their pulmonary function and itself presents an obstacle to performing further CPEX studies, as the upper and lower respiratory tracts are no longer in communication. There is no specific device that has yet been agreed upon in the medical community to overcome this challenge. Method We used a cuffed laryngectomy tube with a compressed concertina catheter mount and attached this to the CPEX flow sensor using a connector from a 3-litre calibration syringe.