Gastric transposition for pharyngolaryngo-oesophageal cancer: the Unicamp experience

Abstract

Carcinomas of the pharyngo-oesophageal junction continue to be a challenge to head and neck surgeons. We report a series of 30 patients who underwent gastric transposition for advanced pharyngo-oesophageal tumours, with personal insights about the surgical technique and the need for neck and mediastinal node dissection. The median hospital stay was 21.6 days, with resumption of oral feedings around the 16th day in 91.7 per cent of the surgical survivors. Ten patients had multiple primary tumours (33.3 per cent), with 20 per cent of synchronous carcinomas. Serious local and systemic complications occurred in 17 patients (56.7 per cent), the most important being tracheal complications, cervical and systemic infections, fistulas, rupture of major vessels and pulmonary embolus. Post-operative deaths occurred in 20 per cent of the patients. The locoregional control of disease was significant (only 14.2 per cent of deaths from regional recurrence) but 64.2 per cent of the patients died from distant metastasis. Survival without disease was 13.3 per cent at five years. Gastric transposition was judged to be the procedure of choice for palliation or occasional cure in patients with pharyngo-oesophageal tumours.

Neck and mediastinal node dissection in pharyngolaryngoesophageal tumors

“…25 The impact of the TPLEGT on thyroid and parathyroid function was reported previously and occurred because of the extent of the primary tumors and not because of the mediastinal dissection, in our opinion. 26 Thirty-four percent of the patients had total thyroidectomy, 69% had hypoparathyroidism develop in the im- Tables 4 and 5 summarize the reports on TPLEGT that mention specifically cervical and mediastinal metastasis in pharyngolaryngoesophageal tumors, according to the respective primary sites (larynx, hypopharynx, esophagus) and according to the whole group of patients reported. When individualized by primary site, the cervical metastasis in pharyngolaryngoesophageal tumors showed a high frequency of metastasis in laryngeal tumors (75%), hypopharyngeal tumors (57.6%), and pharyngoesophageal tumors as an entire group (53.3%).…”

Thyroidectomy and hypoparathyroidism in patients with pharyngoesophageal tumors

“…The advanced stage of the primary tumor prevented us from preserving the parathyroid glands in many of our patients. The impact of TPLEGT on thyroid and parathyroid function has been described15 but was slightly different in this study. Although in recent years we have tended to preserve at least one lobe of the thyroid when possible, in many patients we feared involved margins.…”

“…Although not part of the main objective of this work, additional relevant data published elsewhere15–17 are included here to allow a more complete analysis of this study. Locoregional (33 patients; 82.5%) and systemic (22 patients; 55%) complications were prominent in this series of patients.…”

“…However, in some patients, this procedure can offer effective alleviation and occasional cure. The criteria for indicating and excluding patients from this procedure have been discussed 1–17. Survival is generally poor, and the prognosis is worsened by the presence of cervical or mediastinal lymph nodes (incidence of 47.5% and 42.5%, respectively), high multicentricity, and a high incidence of distant metastasis 15–17.…”

“…The treatment of advanced pharyngoesophageal tumors with total pharyngolaryngoesophagectomy and gastric transposition (TPLEGT) has been recommended since 1960 1–17. However, this procedure has a high risk of locoregional and systemic complications.…”