Hypoparathyroidism following total laryngopharyngectomy and gastric pull‐up

Abstract

We have used the gastric pull-up technique for closure of large pharyngoesophageal defects after radical oncological surgery since 1979. The management of severe hypocalcemia and hypovitaminosis D seemed more difficult in patients undergoing pull-up reconstruction than in patients undergoing the same extirpative surgery, but reconstructed with more traditional methods. To determine if hypocalcemia and hypovitaminosis D were more common in gastric pull-up patients, and if postoperative management of these conditions is more problematic in this group, we retrospectively compared three groups of head and neck surgery patients. Group 1 consisted of 17 patients undergoing total laryngectomy with thyroid complex preservation. Group 2 consisted of 7 patients undergoing mediastinal dissection with total laryngectomy-thyroidectomy previously or concurrently. Group 3 consisted of 30 patients undergoing total laryngopharyngoesophagectomy-thyroidectomy and gastric pull-up reconstruction. The incidences of hypocalcemia requiring therapy were 12%, 50%, and 73%, respectively, with an overall incidence of 51%. The average amounts of supplemental calcium and vitamin D in the three groups were compared. A significant between the three groups was noted. Finally, the dietary calcium and vitamin D requirements for one problematic patient were prospectively recorded and summarized graphically. We conclude that any patient should be carefully monitored for the signs and symptoms of hypocalcemia after major head and neck surgery. In the special instance of the gastric pull-up patient, calcium requirements and the range of serum calcium fluctuation are greatly increased compared to patients undergoing more traditional methods of reconstruction.

Recurrent laryngeal cancer presenting as delayed hypoparathyroidism

“…Hypoparathyroidism after treatment for laryngeal and hypopharyngeal cancer has been previously described and may occur as a sequela of tumor invasion, surgery, radiation, and combined therapy 4–6. Its occurrence following surgery alone, with reported incidences of 0 to 89%,1, 3–7 typically manifests within a few days after surgery and may be either transient or permanent. Multiple etiologies are associated with the occurrence of transient hypocalcemia, including temporary hypoparathyroidism, electrolyte abnormalities (hypomagnesemia), nutritional deficiencies (albumin, calcium, vitamin D), and intravascular fluid shifts (blood loss, transfusion, and replacement fluid).…”

Thyroidectomy and hypoparathyroidism in patients with pharyngoesophageal tumors

“…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.…”

“…Table 5 summarizes the eight available literature reports on hypoparathyroidism and TPLEGT,1, 6, 8, 10, 11, 13, 14 together with this study. Note that the median percentage of hypoparathyroidism was calculated on the basis of the specific numbers reported and the numbers of the total group.…”

“…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.…”

“…As a result, a considerable number of patients may have hypoparathyroidism (HP) develop. The objective of this article is to report our experience with different types of thyroidectomy, to describe the relationship of thyroidectomy to HP in TPLEGT, and also to compare our results with data in the literature 1, 2, 6, 8, 10, 11, 13, 14…”