Partial vs Total Esophagectomy for Advanced Carcinoma of the Hypopharynx

Larynx‐preserving esophagectomy and jejunal transfer for cervical esophageal carcinoma

“…In particular, patients with high cervical esophageal carcinomas involving the hypopharynx are usually not considered candidates for larynx‐preserving surgery. Many surgeons believe that larynx preservation is possible in only carefully selected cases and that total laryngectomy is usually necessary 6, 7. The safety and reliability of larynx‐preserving cervical esophagectomy has not been established.…”

“…However, thoracic esophagectomy and manipulation of the mediastinum can lead to fatal cardiopulmonary complications 8. Reported perioperative death rates with gastric pull‐up have ranged from 6.3% to 7.3% 7, 8, 10, 14. Another disadvantage of gastric pull‐up is that the loss of function of the lower esophageal sphincter causes gastroesophageal reflux, which may result in persistent aspiration if the larynx is preserved 13, 14.…”

Larynx preservation in surgical treatment of cervical esophageal cancer - combined procedure of laryngeal suspension and cricopharyngeal myotomy

“…The most important problem for larynx preservation is the surgical margin of the tumor residue of the proximal and distal sites. Some investigators have reported that total esophagectomy with larynx preservation might be proposed in carefully selected patients with cervical esophageal cancer to obtain a proximal surgical margin of at least 2–3 cm 14 , 15 . However, another indication for larynx preservation may be a tumor treated with radiochemotherapy when adequate downstaging is obtained 2 , 16 .…”

“…Some investigators have reported that total esophagectomy with larynx preservation might be proposed in carefully selected patients with cervical esophageal cancer to obtain a proximal surgical margin of at least 2±3 cm. 14,15 However, another indication for larynx preservation may be a tumor treated with radiochemotherapy when adequate downstaging is obtained. 2,16 In the present study, it was possible to perform the laryngeal-preserving procedure in 10 out of 22 (45%) patients with hypopharyngeal and cervical esophageal cancer who had a good response to radiochemotherapy (histological grade 3, four cases and grade 2, six cases) and whose tumors had not invaded to the hypopharynx.…”

Evaluation of a new diagnostic modality for distal assessment of advanced, obstructing hypopharyngeal cancer

“…There has been a considerable amount of controversy in the literature about the necessity of total oesophageal resection in cases of advanced hypopharyngeal cancer. 12 Those in favour of TLPO have argued that the high incidence of multicentric tumours in these patients justifies resection of all the so-called 'condemned' upper laryngopharyngoesophageal mucosa. 8 However, the higher perioperative mortality as well as morbidity rates observed once the surgical resection is carried beyond the neck region into the mediastinum and abdomen have led most authors 12 -14 to refrain from performing unnecessary routine oesophagectomies in all patients.…”