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Int J Clin Exp Med. 2014 Sep 15;7(9):2771-8. eCollection 2014.

Surgical management of cervical esophageal carcinoma with larynx preservation and reconstruction.

Author information

1
Department of Otorhinolaryngology, Qilu Hospital, Shandong University, Key Laboratory of Otolaryngology, Ministry of Health Jinan 250012, Shandong, P. R. China ; Department of Otorhinolaryngology, Central Hospital of Zibo Shandong Province, P. R. China.
2
Department of Otorhinolaryngology, Qilu Hospital, Shandong University, Key Laboratory of Otolaryngology, Ministry of Health Jinan 250012, Shandong, P. R. China.
3
Department of Thoracic Surgery, Qilu Hospital, Shandong University P. R. China.
4
Department of Radiation, Oncology Center, Qilu Hospital of Shandong University Jinan 250012, Shandong, P. R. China.
5
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center Houston, TX 77030, USA.

Abstract

OBJECTIVES:

There is no generally accepted treatment strategy for cervical esophageal carcinoma. The purpose of this study was to evaluate the operative outcomes of reconstruction after resection of cervical esophageal and hypopharynx-esophagus junction carcinoma with larynx preservation.

METHODS:

We retrospectively reviewed the data of 79 patients with carcinoma of the hypopharynx-esophagus junction and cervical esophagus. Transhiatal total esophagectomy without thoracotomy was carried out in 67 patients who underwent gastric pull-up (GP) or colon interposition (CI) techniques. Transcervical limited pharyngo-cervical esophagectomy was performed in the patients with the pectoralis major flap alone or combined with the split graft (PMF/CWSG) for reconstruction. Seventy-two patients received postoperative adjuvant therapy.

RESULTS:

The 3-year and 5-year overall survival rates were 66.4% and 45.5%, respectively. The average time to resumption of oral feeding was 25.2 days. All patients had preserved laryngeal function. The overall incidence of complications was 29.1% (23/79), which included cervical fistula, abdominal wound dehiscence, liquefaction necrosis of abdominal fat, and pleural effusion.

CONCLUSIONS:

Surgical resection of cervical esophageal carcinoma and laryngeal preservation is possible. Complete esophagectomy should be performed when the resection extends below the thoracic inlet. The reconstruction methods we performed were safe and effective for the immediate restoration of alimentary continuity after resection of cervical esophageal and pharyngo-cervical esophageal carcinoma; and the patients with PMF/CWSG reconstruction had a better survival than those with GP or CI reconstruction. Combined with radiotherapy, the resectability rate and survival rate of cervical esophageal carcinoma can be improved.

KEYWORDS:

Carcinoma; cervical esophagus; colon interposition; gastric pull-up; larynx preservation; oral cancer

PMID:
25356138
PMCID:
PMC4211788

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