OUTCOME ANALYSIS OF TOTAL LARYNGOPHARYNGEAL OESOPHAGECTOMY IN CARCINOMA HYPO-PHARYNX AND CERVICAL ESOPHAGUS, WITH STOMACH RECONSTRUCTION
AbstractBackground: 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
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.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.