Laryngopharyngoesophagectomy for advanced hypopharyngeal and esophageal squamous cell carcinoma: The yale experience

Abstract

The 5-year survival rate for patients with hypopharyngeal squamous cell carcinoma invading the upper esophagus is below 25% regardless of therapy. Most patients with advanced disease--unable to eat or breathe--die within 18 months of diagnosis. Because these patients, on average, have a limited time to live, surgical treatment should aim to maximize the quality of remaining life. Essential to this goal are complete tumor removal and rapid return to oral feeding. Furthermore, short hospital stay and low perioperative morbidity are especially important in these patients. We performed total laryngopharyngoesophagectomy (LPE) with gastric transposition in 34 patients with hypopharyngeal and cervical esophageal squamous cell carcinoma. There has been one perioperative death (3%) and 1 temporary fistula (3%). No major mediastinal or intrathoracic complication occurred. On average, patients began oral feeding by postoperative day 10, with return to a full diet and discharge home within 16 days, maximizing both quality and quantity of time remaining outside the hospital.

Intraoperative brachytherapy, laryngopharyngoesophagectomy, and gastric transposition for patients with recurrent hypopharyngeal and cervical esophageal carcinoma

“…Although a variety of surgical approaches and reconstructive methods are used, the method of choice at our institution for the surgical management of disease recurrence involving the hypopharynx and/or cervical esophagus is LPE with GT. Sasaki et al 5 reported on a cohort of 34 patients, with 27 undergoing total LPE and 7 being managed with pharyngoesophagectomy. Sixteen patients had previously been treated with surgical resection, and 18 had been previously irradiated.…”

“…The LPE procedure has been previously described in detail 5 . Tumor resectability is determined by the head and neck surgical team, and at that juncture the larynx is mobilized from the trachea, and the pharynx is entered and transected.…”

“…The surgical management of hypopharyngeal recurrence is technically challenging, and patients may undergo laryngopharyngoesophagectomy (LPE) with reconstruction 5,6 . Such reconstruction may be performed with a variety of methods, and these may include jejunal or colonic interposition, myocutaneous flaps, or gastric transposition (GT).…”

Free Jejunal Graft for Reconstruction of Defects in the Hypopharynx and Cervical Esophagus Following the Cancer Resections

“…2,3 With the development and experiences of microsurgical techniques, the free jejunal graft for reconstruction of the esophagus defect has gained wide acceptance. 4 Despite very aggressive therapeutic measures, this technique has many advantages, for example, (1) the first stage of anastomotic procedure shows little impact on the digestive system with low rate of surgical complications; (2) the jejuna with a large and adequate vasculature provides freedom selection for mesenteric vessels to harvest the intestine; (3) free jejunal graft may provide a greater range of security for the tumor resection by a harvest of sufficient However, the free jejunal reconstruction has its limitation, for example, the lesion extended or located below the thoracic inlet will be unsafe for anastomosis to transecting margin of the esophagus, [5][6][7] and this technique is performable only in the condition of disorder free in the thoracic esophagus and intestine. 9 Moreover, free jejunal reconstruction may complicate with wound healing, hemorrhage, 10,11 necrosis, 12 pulmonary infections, and fistula.…”

“…[5][6][7] The goal of the free jejunal graft is a single stage reconstruction with low morbidity and mortality, short hospital stay, and early restoration of swallowing.…”