During the last 14 years, pharyngogastric anastomosis following pharyngolaryngoesophagectomy was performed in 157 patients, among whom 67 had carcinoma of the hypopharynx, 7 had carcinoma of the cervical esophagus, and 83 had carcinoma of the larynx involving the hypopharynx. The operative procedure was that described previously by Ong in 1960, and modified in 1971. The overall hospital mortality was 31%, which in the last 2 years of the study had fallen to 18%. It was found that the mortality was higher in patients with poor cardiopulmonary status and in patients whose tumors had extended into the vallecula, thus requiring resection of the posterior third of the tongue. Previous failed radiotherapy increased the risk of leakage of the anastomosis. The immediate results of the operation can be improved if the surgeon ensures that a healthy stomach is prepared, a secure anastomosis is performed, and the vulnerable blood vessels are protected. Postoperative function in terms of swallowing ability was good, but rehabilitation of speech was poor. The 5‐year survival rate was 17.8%. The longest surviving patient is still alive 10 years after the original operation. The most common cause of long‐term failure was the development of metastatic disease. Improvement in survival results may require the use of adjuvant therapy to operative treatment.
Gastrostomy feeding has been a well established form of nutritional support for patients presenting with total dysphagia for carcinoma of the oesophagus. More recently, total parenteral nutrition has proved to be efficient and safe, offering an alternative to gastrostomy feeding. Twenty-four patients were randomly selected into two groups to compare the efficacy of total parenteral nutrition and gastrostomy feeding with respect to nitrogen balance and weight gain. Total parenteral nutrition was found to be superior to gastrostomy feeding in achieving an earlier positive nitrogen balance and greater weight gain during a 4-week period. However, gastrostomy feeding is still preferred as it is cheap, simple and safe, and allows patients to be active, mobile and self dependent. Total parenteral nutrition is reserved for those patients in whom an earlier operation is advisable.
Chylothorax complicating operations on the oesophagus has been reported infrequently; it carries a mortality rate of about 50 per cent. A search of the literature has yielded only 10 cases. This paper reports 4 further cases which occurred among 685 resections of the oesophagus, giving an incidence of 0.6 per cent. The diagnosis should be confirmed with lymphangiography. Treatment should be early exploration and ligation in patients in whom the thoracic duct has been divided at operation. If the duct has been injured during blind dissection a period of conservative treatment is advisable. Parenteral nutrition is a useful adjunctive treatment.
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