Abstract
Purpose
Squamous cell cancer (SCC) of the pharyngoesophageal junction area has a poor prognosis mainly due to late symptom manifestation and diagnosis. Treatment of choice is still pharyngolaryngoesophagectomy, substantially affecting quality of life. Limited surgical procedures have been adopted as well. The aim of this retrospective study was to evaluate whether the extent of resection influences postoperative safety and mortality.
Methods
From 1984 to 2006, 66 patients were operated at a single tertiary referral center. Nineteen patients (28.8 %) had SCC of the hypopharynx and 47 patients (71.2 %) had SCC of the cervical and cervicothoracic esophagus. Thirty-five patients (53.0 %) underwent cervical esophageal resection (CE) and 31 underwent total esophagectomy (TE). In 39 patients (59.1 %), the larynx was preserved. Thirteen patients (19.7 %) underwent multimodal treatment.
Results
Overall postoperative morbidity was 69.7 % and reoperation rate reached 28.8 %. TE (P = 0.03) and larynx preservation (P = 0.02) were followed by a higher rate of non-lung infections compared with CE and pharyngolaryngectomy, respectively. Pulmonary complications have been observed more frequently after larynx preservation (P = 0.02). Hospital mortality was 9.1 %. Four patients died after TE (12.9 %) and two patients died after CE (5.7 %). In all of them, the larynx had been preserved (15.4 %). Overall, 53 patients (80.3 %) died until follow-up. One-year and 5-year survival in patients with the major tumor burden at the cervicothoracic site was 35.7 and 0 %.
Conclusions
CE can be recommended as long as R0 resection is warranted. The advantage of larynx preservation is gained by higher morbidity and mortality rates and may not be recommended as standard procedure. Surgery may not be appropriate for advanced SCC in the cervicothoracic region.
Similar content being viewed by others
References
Wang LS, Huang MH, Huang BS, Chien KY (1992) Gastric substitution for respectable carcinoma of the esophagus: an analysis of 368 cases. Ann Thorac Surg 53:289–294
Mehta SA, Sarkar S, Mehta AR, Mehta MS (1990) Mortality and morbidity of primary pharyngogastric anastomosis following circumferential excision for hypopharyngeal malignancies. J Surg Oncol 43:24–27
Seidenberg B, Rosenak SS, Hurwitt ES, Som ML (1959) Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 149:162–171
Ong GB, Lee TC (1960) Pharyngogastric anastomosis after oesophago-pharyngectomy for carcinoma of the hypopharynx and cervical oesophagus. Br J Surg 48:193–200
Griffiths JD, Shaw HJ (1973) Cancer of the laryngopharynx and cervical esophagus. Arch Otolaryngol Head Neck Surg 97:340–346
Schechter GL, Baker JW, El-Mahdi AM, Bumatay JT (1982) Combined treatment of advanced cancer of the laryngopharynx and cervical esophagus. Laryngoscope 92:11–15
Surkin MI, Lawson W, Biller HF (1984) Analysis of the methods of pharyngoesophageal reconstruction. Head Neck Surg 6:953–970
Cadière G-B, Dapri G, Capelluto E, Himpens J (2006) Esophagectomy by thoracoscopy with patient in prone position, laparoscopy and cervicotomy. Eur Surg 38:164–170
Hölscher AH, Vallböhmer D, Schröder W, Bollschweiler E (2007) Limited surgery for ‘early’ cancer of the esophagus. Eur Surg 39:273–280
Langer FB, Zacherl J (2007) Palliative endoscopic interventions in esophageal cancer. Eur Surg 39:288–294
Ashrafi AS, Keeley SB, Shende M, Luketich JD (2007) Minimally invasive esophagectomy. Eur Surg 39:141–150
Panhofer P, Izay B, Prager G et al (2010) Review: gastrointestinal reconstructions in 1200 patients with cancer at the pharyngoesophageal junction. Eur Surg 42:38–48
Fujita H, Kakegawa T, Yamana H et al (1999) Total esophagectomy versus proximal esophagectomy for esophageal cancer at the cervicothoracic junction. World J Surg 23:486–489
Marmuse JP, Koka VN, Guedon C, Benhamou G (1995) Surgical treatment of carcinoma of the proximal esophagus. Am J Surg 169:386–390
Peracchia A, Bonavina L, Botturi M et al (2001) Current status of surgery for carcinoma of the hypopharynx and cervical esophagus. Dis Esoph 14:95–97
Kelley DJ, Wolf R, Shaha AR et al (1995) Impact of clinicopathologic parameters on patient survival in carcinoma of the cervical esophagus. Am J Surg 170:427–431
Bussi M, Ferrero V, Riontino E et al (2000) Problems in reconstructive surgery in the treatment of carcinoma of the hypopharyngeal junction. J Surg Oncol 74:130–133
Schusterman MA, Shestak K, deVries EJ et al (1990) Reconstruction of the cervical esophagus: free jejunal transfer versus gastric pull-up. Plast Reconstr Surg 85:16–21
Wei WI, Lam LK, Yuen PW, Wong J (1998) Current status of pharyngolaryngo-esophagectomy and pharyngogastric anastomosis. Head Neck 20:240–244
Wang HW, Chu PY, Kuo KT et al (2006) A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction. J Surg Oncol 93:468–476
Gluckmann JL, Weissler MC, McCafferty G et al (1987) Partial vs total esophagectomy for advanced carcinoma of the hypopharynx. Arch Otolaryngol Head Neck Surg 113:69–72
Bumm R, Feith M, Lordick F, Herschbach P, Siewert JR (2007) Impact of multidisciplinary tumour boards on diagnosis and treatment of esophageal cancer. Eur Surg 39:136–140
Hejna M (2007) State of the art and future perspectives in cytostatic treatment of esophageal cancer. Eur Surg 39:151–157
Zacherl J, Neumayer C, Langer F (2006) Esophageal cancer: international guidelines in interdisciplinary diagnosis and treatment. Eur Surg 38:79–88
Kelling GE (1911) Oesophagoplasty with the help of the transverse colon. Zentralbl Chir 36:1209–1212
Shiozaki H, Tsujinaka T, Inoue M et al (2000) Larynx preservation in surgical treatment of cervical esophageal cancer—combined procedure of laryngeal suspension and cricopharyngealmyotomy. Dis Esoph 13:213–218
Triboulet JP, Mariette C, Chevalier D, Amrouni H (2001) Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases. Arch Surg 136:1164–1170
Spiro RH, Bains MS, Shah JP, Strong EW (1991) Gastric transposition for head and neck cancer: a critical update. Am J Surg 162:348–352
Coleman JJ III, Searies JM, Hester TR et al (1987) Ten years experience with the free jejunalautograft. Am J Surg 154:394–398
Harrison DF, Thompson AE (1986) Pharyngolaryngoesophagectomy with pharyngogastric anastomosis for cancer of the hypopharynx: review of 101 operations. Head Neck Surg 8:418–412
Ott K, Lordick F, Molls M et al (2009) Limited resection and free jejunal graft interposition for squamous cell carcinoma of the cervical oesophagus. Br J Surg 96:258–266
Stahl M, Stuschke M, Lehmann N et al (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23:2310–2317
Bedenne L, Michel P, Bouché O et al (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25:1160–1168
Goldberg M, Freeman J, Gullane PJ et al (1989) Transhiatal esophagectomy with gastric transposition for pharyngolaryngeal malignant disease. J Thorac Cardiovasc Surg 97:327–333
Carlson GW, Schusterman MA, Guillamondegui OM (1992) Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience. Ann Plast Surg 29:408–412
Böttger T, Bumb P, Dutkowski P et al (1999) Carcinoma of the hypopharynx and the cervical oesophagus: a surgical challenge. Eur J Surg 165:940–946
Affleck DG, Karwande SV, Bull DA et al (2000) Functional outcome and survival after pharyngolaryngoesophagectomy for cancer. Am J Surg 180:546–550
Peracchia A, Bardini R, Roul A et al (1990) Surgical management of carcinoma of the hypopharynx and cervical esophagus. Hepato-Gastroenterol 37:371–375
Ancona E, Pianalto S, Merigliano S et al (1995) Esophageal reconstruction: free jejunal transfer for the reconstruction of the pharyngo-esophagus. Dis Esoph 8:40–43
Schultz-Coulon HJ (2001) Jejunum interposition after cervical esophageal resection. Dis Esoph 14:13–16
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Panhofer, P., Springer, C., Izay, B. et al. Influence of resection extent on morbidity in surgery for squamous cell cancer at the pharyngoesophageal junction. Langenbecks Arch Surg 398, 221–230 (2013). https://doi.org/10.1007/s00423-012-0995-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-012-0995-8