OUTCOME ANALYSIS OF TOTAL LARYNGOPHARYNGEAL OESOPHAGECTOMY IN CARCINOMA HYPO-PHARYNX AND CERVICAL ESOPHAGUS, WITH STOMACH RECONSTRUCTION

Authors

  • Farhan Ahmad Majeed Combined military Hospital and Medical college, Multan
  • Sohail Aslam PNS Hospital Shifa, Karachi
  • Shahid Farooq Combined Military Hospital and Medical College, Multan.
  • Ahmad Ali Combined military Hospital and Medical College, Lahore.
  • Ahmed Raza Combined military hospital Kharian.
  • Usama Zafar Combined Military hospital and Medical College, Multan

Abstract

Background: Upper cervical oesophageal and hypo-pharyngeal malignancies pose significant challenges in surgical management. In advanced tumours total laryngopharyngeal esophagectomy (TLPO) and gastric pull up provides excellent result. Methods: It is a descriptive case series and was conducted from Jan 2010 to Jan 2017. 35 patients underwent TLPO. The inclusion criteria were; tumours of hypo-pharynx which allow tumour free resection margins and cervical oesophageal tumours not involving mediastinal trachea. There were no clinically palpable cervical lymph nodes. Patients with locoregional advanced disease and poor performance status were excluded. All cases underwent standard one stage TLPO with bilateral inter-jugular lymph nodal clearance. Minimal invasive techniques used in three cases. Results: Out of 35 patients, n=21 (60%) of patient had lesion of hypopharynx with post cricoid involvement, n=13 (37.1%) had primary tumour of cervical oesophagus abutting pharynx and cricoid and only one patient had a tumour of hypopharynx with perforation. Histopathological conformation of diagnosis done in all patients preoperatively which showed Well differentiated Squamous cell in n=19 (54.28%), moderately differentiated squamous cell in 28.57% (n=10). Post-operative staging of the patients 74.28% (n=26) fall in stage 3. Operative time was less than 3 hours in 17 patients with two team technique, between 3-4 hours in 8 patients and more than 4 hours in 3 patients. SVT in 14.28% (n=5), Atrial Fibrillation in 5.71% (n=2). Chest complications including pneumothorax in 11.43% (n=4), basal atelectasis in 22.86% (n=8), pulmonary embolism in 2.85% (n=1), aspiration in 8.57% (n=3) and tracheal stenosis in n=1, 5.71% (n=2) cases had anastomotic leak . Postop 28 days mortality was 8.57% (n=3). Conclusions:  TLPO with stomach pull up offer good results in patients with resectable disease with acceptable morbidity and mortality in operable patients.

Keywords: Carcinoma hypopharynx; Carcinoma oesophagus, Cervical oesophagus, Laryngopharyngeal esophagectomy

Author Biographies

Farhan Ahmad Majeed, Combined military Hospital and Medical college, Multan

Proffesor of Thoracic Surgery and Head of Surgery Department CMH Multan.

Sohail Aslam, PNS Hospital Shifa, Karachi

HOD ENT department, PNS Hospital Shifa Karachi

Shahid Farooq, Combined Military Hospital and Medical College, Multan.

Assosiate proffesor at ENT department, CMH Multan.

Ahmad Ali, Combined military Hospital and Medical College, Lahore.

Registrar of Thoracic Surgery Department at CMH Lahore

Ahmed Raza, Combined military hospital Kharian.

HOD Thoracic Surgery CMH Kharian.

Usama Zafar, Combined Military hospital and Medical College, Multan

Senior Registrar and Clinical cordinator at CMH and Medical college Multan.

References

Denever A, Khater A, Hafez MT, Hussein O, Rushdy S, Shahatto F, et al. Pharyngoesophageal Reconstruction after Resection of Hypopharyngeal Carcinoma: a new algorithm after analysis of 142 cases. World J Surg Oncol 2014;12:182.

Steiner W, Ambrosch P, Ambrosch P, Hess CF, Kron M. Organ preservation by transoral laser microsurgery in pyriform sinus carcinoma. Otolaryngol Head Neck Surg 2001;124(1):58-67.

Bierre SS, Maas KW, Cuesta MA, van dar Peet DL. Cervical or Thoracic anastomosis after esophagectomy for cancer: a systematic review and Meta analysis. Dig Surg 2011;28(1):29-35.

Oezcelik A, Kaiser GM, Niebel W, Sleyman C, Trackmann GW, Sotiropulos GC, et al. Ten-year survival of esophageal cancer after an en-block esophagectomy. J Surg Oncol 2012;105(3):284-7.

Wei WI, Lam LK, Yuen PW, Wong J. Current status of pharyngolaryngoesophagectomy and pharyngo gastric anastomosis. Head Neck 1998;20(3):240-4.

Lagarde SM, Vrouenraets BC, Stassen LP, Van Lanschot JJ. Evidence based surgical treatment of esophageal cancer: Overview of high-quality studies. Ann Thorac Surg 2010;89(4):1319-26.

Boddy AP, Williamson JML, Vipond MN. The effect of centralization on outcomes of esophagogastric surgery. A fifteen year audit. Int J Surg 2012;10(7):360-3.

Ferlito A, Shaha AR, Buckley JG, Rinaldo A. Selective neck dissection for hypopharyngeal cancer in clinically negative neck: should it be bilateral? Acta Otolaryngol 2001;121(3):329-35.

Pesko P, Sabljack P, Bjelovic M, Stojakov D, Simic A, Nenadic B, et al. Surgical treatment and clinical course of patient with hypopharyngal carcinoma. Dis Esophagus 2006;19(4):248-53.

Zhang M, Wu QC, Li Q, Jiang YG, Zhang C, Chen D. Comparison of health-related quality of life in patients with narrow gastric tube and whole stomach reconstruction after oncologic esophagectomy: a prospective randomized study. Scand J Surg 2013;102(7):77-82.

Dadhat SB, Mistry RC, Fakih AR. Complication following gastric transposition after total laryngopharyngectomy. Eur J Surg Oncol 1999;25(1):82-5.

LiorentePendas JL, Lopez Liames A, Gonzalaz JJ, NaravveteGuijosa F, Rodriguez Prado N, Saurez Nieto C. Gastric pull-up reconstruction in hypopharyngal and cervical esophageal cancer. Acta Otorrinolaringol Esp 2006;57(5):242-6.

Triboulete JP, Mariette C, Chevalier D, Amrouni H. Surgical management of carcinoma of hypopharynx and cervical esophagus: analysis of 209 cases. Arch Surg 2001;136(10):1164-70.

Hashmi S, Smith M. Medical evaluation of patients preparing for an esophagectomy. Surg Clin North Am 2012;9295):1127-33.

Baknos CT, Fabian T, Oyasiji TO, Gautam S, Gangadharan SP, Kent MS, et al. Impact of surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg 2012;93(1):221-7.

To Ew, Tsaug WM, William MD, Pang PC, Cheng JH, Chan AC. Reconstruction challenge--Combined use of pectoralis major and gastric pull up flaps for massive naso-oropharyngeal/ esophageal defects. Asian J Surg 2002;25(4):337-40.

Movita M, Saeki H, Ito S, Ikeda K, Yamashita N, Ando K, et al. Technical improvement of total pharyngo-laryngo-esophagectomy for esophageal cancer and head and neck cancer. Ann Surg Oncol 2014;21(5):1671-7.

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Published

2020-02-05

How to Cite

Majeed, F. A., Aslam, S., Farooq, S., Ali, A., Raza, A., & Zafar, U. (2020). OUTCOME ANALYSIS OF TOTAL LARYNGOPHARYNGEAL OESOPHAGECTOMY IN CARCINOMA HYPO-PHARYNX AND CERVICAL ESOPHAGUS, WITH STOMACH RECONSTRUCTION. Journal of Ayub Medical College Abbottabad, 32(1), 13–17. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/6380

Issue

Vol. 32 No. 1 (2020): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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