WASHINGTON – A Massachusetts man has regained his voice after surgeons removed his cancerous larynx and, in a pioneering move, replaced it with a donated one.
Transplants of the so-called voice box are extremely rare and are typically not an option for people with active cancer. Marty Kedian is only the third person in the U.S. to undergo a total larynx transplant — the others years ago due to injury — and one of the few reported worldwide.
Surgeons at the Mayo Clinic in Arizona offered the transplant to Kedian as part of a new clinical trial that aims to open the potentially life-changing operation to more patients, including some with cancer, the most common way to lose a larynx.
“People need to keep their voices,” Kedian, 59, told The Associated Press four months after his transplant — still hoarse but able to hold an hour-long conversation. “I want people to know it can be done.”
He became emotional as he recalled the first time he called his 82-year-old mother after surgery “and she could hear me. … That was important for me, talking to my mom.”
The study is small – only nine more people will be enrolled. But it can teach scientists best practices for these complex transplants, so that one day they can be offered to more people who cannot breathe, swallow or speak for themselves due to a damaged or surgically removed larynx.
“Patients become very reclusive and isolated from the rest of the world,” said Dr. David Lott, chief of head and neck surgery at Mayo in Phoenix. He started the study because “my patients tell me, ‘Yes, I may be alive, but I’m not really alive.’”
Lott’s team reported the first results of the surgery Tuesday in the journal Mayo Clinic Proceedings.
The larynx may be better known as the voice box, but it is also vital for breathing and swallowing. Flaps of muscular tissue called vocal cords open to let air into the lungs, close to prevent food or drink from going the wrong way – and vibrate as air passes through them to produce speech.
The first two larynx transplant recipients in the U.S. — at the Cleveland Clinic in 1998 and at the University of California, Davis, in 2010 — lost their voices due to injuries, one from a motorcycle accident and the other damaged by a hospital ventilator.
But cancer is the biggest reason. The American Cancer Society estimates that more than 12,600 people will be diagnosed with some form of laryngeal cancer this year. Although many today undergo voice-preserving treatment, thousands of people have had their larynx completely removed, breathing through a so-called tracheostomy tube in their neck and struggling to communicate.
Although the first U.S. recipients achieved near-normal speech, doctors did not embrace these transplants. In part, this is because people can survive without a larynx — while anti-rejection medications that suppress the immune system can trigger new or recurring tumors.
“We want to be able to push those limits, but do it as safely and ethically as possible,” Lott said.
Head and neck experts say the Mayo study is critical in helping laryngeal transplants become a viable option.
“It’s not a one-time thing,” but an opportunity to finally learn from one patient before operating on the next, said Dr. Marshall Strome, who led the 1998 transplant in Cleveland.
This first attempt on a cancer patient “is the next important step,” he said.
Other options are being studied, noted Dr. Peter Belafsky of UC Davis, who helped perform the 2010 transplant. His patients at high risk for larynx loss record their voices in anticipation of next-generation speech devices that sound like they.
But Belafsky said there is “still a chance” that laryngeal transplants will become more common, while cautioning that more years of research will likely be needed. One hurdle has been getting enough nerve growth to breathe without a tracheal tube.
Kedian was diagnosed with a rare laryngeal cartilage cancer about a decade ago. The Haverhill, Massachusetts, man underwent more than a dozen surgeries, eventually needing a tracheal tube to help him breathe and swallow — and had trouble even making a hoarse whisper through it. He had to retire due to disability.
Still, the once-gregarious Kedian, known for long conversations with strangers, wouldn’t let doctors remove his entire larynx to cure his cancer. He desperately wanted to read bedtime stories to his granddaughter, with his own voice, instead of what he called robotic-sounding speaking devices.
Then Kedian’s wife, Gina, located the Mayo study. Lott decided he was a good candidate because his cancer wasn’t growing quickly and—especially important—Kedian was already taking anti-rejection medications for a previous kidney transplant.
It took 10 months to find a deceased donor with a healthy larynx of the right size.
Then, on February 29, six surgeons operated for 21 hours. After removing Kedian’s cancerous larynx, they transplanted the donor one, as well as the necessary surrounding tissues – thyroid and parathyroid glands, pharynx and upper part of the trachea – and tiny blood vessels to supply them. Finally, using new microsurgical techniques, they connected essential nerves so Kedian could feel when he needed to swallow and move his vocal cords.
About three weeks later, Kedian said “hello.” Soon he relearned how to swallow, moving from applesauce to macaroni and cheese to hamburgers. He said hi to his granddaughter Charlotte via video, part of his homework to keep talking.
“Every day it’s getting better,” said Kedian, who will return to Massachusetts soon. His tracheostomy remains in place for at least a few more months, but “I’m trying hard to make it happen faster because I want these tubes out of me, to get back to a normal life.”
And just as Lott assured him, Kedian maintained his beloved Boston accent.
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