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World Journal of Surgery

, Volume 26, Issue 5, pp 561–565 | Cite as

Long-term survival of patients with stage IV hypopharyngeal cancer: Impact of fundus rotation gastroplasty

  • Martin K. SchillingEmail author
  • Martin Eichenberger
  • Christoph A. Maurer
  • Richard Greiner
  • Peter Zbären
  • Markus W. Büchler
Original Scientific Reports

Abstract

Stage IV circular hypopharyngeal cancer is a disease with poor long-term survival, and the only means of cure—surgery—is associated with high morbidity. All patients admitted with circular hypopharyngeal cancer and extension to the esophagus were enrolled in a multidisciplinary treatment protocol, including circular laryngopharyngoesophagectomy with tracheostomy, neck dissection, and pull-up of a fundus rotation gastric tube that was anastomosed to the oropharynx. Five weeks postoperatively high-dose radiotherapy (60 Gy) was given to the cervical region. Altogether, 18 qualifying patients were explored cervically, were found to have resectable lesions (i.e., without carotid artery infiltration), and were included in the protocol. After laryngopharyngoesophagectomy, an elongated gastric tube was pulled up to the oropharynx. The average distance bridged with the tube was 32±4 cm. No anastomotic leaks were found on postoperative Gastrografin swallow, and oral feeding was started between days 5 and 8. Patients were discharged with normal oral feeding on day 21 (±17 days). Diarrhea, postprandial fullness, and reflux resolved within 6 months postoperatively. Five patients died during the follow-up period of 42 months (range 3–63 months): three due to cardiac events 18 and 38 months postoperatively and two within 12 months with residual disease and tumor recurrence, respectively. The estimated 5-year survival was 60%. We concluded that an aggressive multidisciplinary approach including circular laryngopharyngoesophagectomy, neck dissection, and high-dose radiotherapy ascertains good long-term survival and good functional results in patients with advanced hypopharyngeal cancer when the intestinal continuity is reconstructed with a fundus rotation gastroplasty.

Keywords

Neck Dissection Gastric Tube Mese Gastrografin Hypopharyngeal Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

En cas de cancer circonférentiel de l’hypopharynx stade IV, la survie est médiocre. Le seul moyen de cure possible, la chirurgie, est grevé d’une morbidité élevée. Tous les patients admis pour cancer circonférentiel de l’hypopharynx avec envahissement de l’œsophage ont été enregistrés dans un protocole de traitement multidisciplinaire, comprenant une laryngopharyngo-oesphagectomie avec trachéostomie, une lymphadénectomie cervicale et une gastroplastie tubulisée au dépens du fundus gastrique anastomosé à l’oropharynx. Cinq semaines après, une radiothérapie à haute dose (de 60 Gy) a été délivrée à la région cervicale. Dix-huit patients remplissant ces conditions ont eu une exploration cervicale et ont été considérés comme potentiellement résecables (c’est-à-dire sans infiltration de l’artère carotide). Après laryngo-pharyngo-esophagectomie, un tube gastrique a été monté à l’oropharynx. La distance moyenne du tube a été de 32±4 cm. Aucune fistule anastomotique n’a été retrouvée sur l’examen postopératoire à la gastrografine et on a pu commencer l’alimentation orale entre les jours postopératoires 5 et 8. Les patients ont pu quitter l’hôpital s’alimentant normalement au jour 21 (±17 jours). En ce qui concerne la morbidité postopératoire, diarrhée, sensation de plénitude postprandiale et reflux se sont résolus en moins de six mois après l’opération. Cinq patients sont décédés pendant la période de suivi de 42 mois (extrêmes 3–63 mois), trois, d’événements cardiaques, 18 et 38 mois postopératoire et deux patients, respectivement, de maladie résiduelle et de récidive tumorale, en moins de 12 mois. La survie à 5 ans a été de 60%. Chez les patients atteints de cancer de l’hypopharynx avancé, une approche multidisciplinaire agressive comprenant une laryngo-pharyngoesophagectomie circulaire, la lymphadénectomie cervicale et la radiothérapie à haute dose, assurent une bonne survie à long terme et de bons résultats fonctionnels lorsque la continuité intestinale est rétablie par une gastroplastie de rotation fundique.

Resumen

El cáncer hipofaríngeo de los pliegues circulares, estadio IV, es una afección con escasa supervivencia a largo plazo y cuya curación, exclusivamente quirúrgica cursa con elevada morbilidad. Todos los pacientes con dicho tipo de cáncer que además, se propaga al esófago, fueron incluidos en un protocolo de tratamiento multidisciplinario consistente en una laringo-faringo-esofagectomía circular con traqueostomía y vaciamiento ganglionar del cuello, anastomosándose un tubo del fundus gástrico rotado a la orofaringe. Transcurridas 5 semanas de la intervención se aplicó sobre la región cervical, radioterapia, a dosis altas: 60 Gy. En 18 pacientes en los que la cervicotomía exploradora demostró la resecabilidad (i.e., sin infiltración de la arteria carótida) se incluyeron en el mencionado protocolo. Tras la laringo-faringoesofagectomía un elongado tubo gástrico se ascendió para anastomosarlo a la orofaringe. La deglución de gastrografin no reveló ninguna dehiscencia anastomótica y la alimentación oral se instauró entre los días 5 y 8 del postoperatorio. Los pacientes fueron dados de alta con alimentación oral normal a los 21 días (±17 días). Diarreas, pesadez postprandial y reflujo desaparecieron a lo largo de los primeros seis meses del postoperatorio. 5 pacientes fallecieron durante el seguimiento, superior a 42 meses (rango 3–63 meses); tres, a los 18 y 38 meses de la intervención por problemas cardiacos; los otros dos murieron antes de 12 meses por enfermedad residual o recidivante. La supervivencia estimada a los 5 años fue del 60%. En pacientes con cáncer hipofaríngeo avanzado un tratamiento agresivo multidisciplinario que incluye no sólo la resección laringo-faringo-esofágica sino también el vaciamiento ganglionar del cuello y radioterapia postoperatoria a dosis altas permite un elevado porcentaje de supervivencia a largo plazo con buenos resultados funcionales, cuando la continuidad del tubo digestivo se restablece con una gastroplastia de rotación fúndica.

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References

  1. 1.
    Zbaren P, Becker M, Lang H. Pretherapeutic staging of hypopharyngeal carcinoma: clinical findings, computed tomography, and magnetic resonance imaging compared with histopathologic evaluation. Arch. Otolaryngol. Head Neck Surg. 1997;123:908–913PubMedGoogle Scholar
  2. 2.
    Zbaren P, Egger C. Growth patterns of piriform sinus carcinomas. Laryngoscope 1997;107:511–518PubMedCrossRefGoogle Scholar
  3. 3.
    Kumar PP, Good RR, Epstein BE, et al. Outcome of locally advanced stage III and IV head and neck cancer treated by surgery and postoperative external beam radiotherapy. Laryngoscope 1987;97:615–620PubMedCrossRefGoogle Scholar
  4. 4.
    Wennerberg J. Pre versus post-operative radiotherapy of resectable squamous cell carcinoma of the head and neck. Acta Otolaryngol. 1995;115:465–474PubMedCrossRefGoogle Scholar
  5. 5.
    Laterza E, Mosciaro O, Urso US. et al. Primary carcinoma of the hypopharynx and cervical esophagus: evolution of surgical therapy. Hepatogastroenterology 1994;41:278–282PubMedGoogle Scholar
  6. 6.
    Kramer S, Gelber RD, Snow JB, et al. Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73-03 of the Radiation Therapy Oncology Group. Head Neck Surg. 1987;10:19–30PubMedCrossRefGoogle Scholar
  7. 7.
    Gluckman JL, Weissler MC, McCafferty G, et al. Partial vs total esophagectomy for advanced carcinoma of the hypopharynx. Arch. Otolaryngol. Head Neck Surg. 1987;113:69–72PubMedGoogle Scholar
  8. 8.
    Frank JL, Garb JL, Kay S. et al. Postoperative radiotherapy improves survival in squamous cell carcinoma of the hypopharynx. Am. J. Sung. 1994;168:476–480CrossRefGoogle Scholar
  9. 9.
    Ong GB, Lee TC. Pharyngo-gastric anastomosis after esophago-pharyngectomy for carcinoma of the hypopharynx and the cervical esophagus. Br. J. Surg. 1960;48:193–200PubMedCrossRefGoogle Scholar
  10. 10.
    Bumm R, Hölscher AH, Fuessner H, et al. Endodissection of the thoracic esophagus: technique and clinical results in transhiatal esophagectomy. Ann. Surg. 1993;218:97–104PubMedCrossRefGoogle Scholar
  11. 11.
    Frank JL, Garb JL, Saul K, et al. Postoperative radiotherapy improves survival in squamous cell carcinoma of the hypopharynx. Am. J. Surg. 1994;168:476–480PubMedCrossRefGoogle Scholar
  12. 12.
    Büchler MW, Seiler C, Baer HU, et al. A technique for gastroplasty as a substitute for the esophagus: fundus rotation gastroplasty. J. Am. Coll. Surg. 1996;182:241–245PubMedGoogle Scholar
  13. 13.
    Schilling MK, Redaelli C, Zbären P. et al. First clinical experience with fundus rotation gastroplasty as a substitute for the oesophagus. Br. J. Surg. 1997;84:126–128PubMedCrossRefGoogle Scholar
  14. 14.
    Schilling MK, Mettler D, Redaelli C, et al. Differences between conventional, reversed and fundus rotation gastric tubes as esophageal replacement. World J. Surg. 1997;21:992–997PubMedCrossRefGoogle Scholar
  15. 15.
    Kajanti M, Mantyla M. Carcinoma of the hypopharynx: a retrospective analysis of the treatment results over a 25-year period. Acta Oncol. 1990;29:903–907PubMedCrossRefGoogle Scholar
  16. 16.
    Olsen KD, Lewis JE, Suman VJ. Spindle cell carcinoma of the larynx and hypopharynx. Otolaryngol. Head Neck Surg. 1997;116:47–52PubMedCrossRefGoogle Scholar
  17. 17.
    Kraus DH, Zelefsky MJ, Brock HA. et al. Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx. Otolaryngol. Head Neck Surg. 1997;116:637–641PubMedCrossRefGoogle Scholar
  18. 18.
    Kojima K, Suzuki K, Ito Y. et al. Tracking of hypopharyngeal carcinoma over 10 years. Acta Otolaryngol. Suppl. 1996;525:146–150PubMedGoogle Scholar
  19. 19.
    Goldsmith HS, Akiyama H. A comparative study of Japanese and American gastric dimensions. Ann. Surg. 1979;190:690–693PubMedCrossRefGoogle Scholar
  20. 20.
    Julieron M, Germain MA, Schwaab G, et al. Reconstruction with free jejunal autograft after circumferential pharyngolaryngectomy: eighty-three cases. Ann. Otol. Rhinol. Laryngol. 1998; 107:581–587PubMedGoogle Scholar
  21. 21.
    Chevalier D, Triboulet JP, Patenotre P, et al. Free jejunal graft reconstruction after total pharyngolaryngeal resection for hypopharyngeal cancer. Clin. Otolaryngol. 1997;22:41–43PubMedCrossRefGoogle Scholar
  22. 22.
    Wilson JA, Maran AG, Pry de A. et al. The function of free jejunal autografts in the pharyngo-oesophageal segment. J.R. Coll. Surg. Edinb. 1995;40:363–366PubMedGoogle Scholar
  23. 23.
    Rath T, Grasl MC, Burian M. et al. Late functional outcome after reconstruction of the upper aerodigestive tract with free transplanted microvascular anastomosed jejunum. Handchir. Mikrochir. Plast. Chir. 1997;29:269–277PubMedGoogle Scholar
  24. 24.
    Barrett WL, Gluckman JL, Aron BS. Safety of radiating jejunal interposition grafts in head and neck cancer. Am. J. Clin. Oncol. 1997:20:609–612; DOI: 10.1097/0000042l-199712000-00016PubMedCrossRefGoogle Scholar
  25. 25.
    Sasaki CT, Salzer SJ, Cahow E, et al. Laryngopharyngoesophageetomy for advanced hypopharyngeal and esophageal squamous cell carcinoma: the Yale experience. Laryngoscope 1995:105: 160–163PubMedCrossRefGoogle Scholar

Copyright information

© the Société Internationals de Chirurgie 2002

Authors and Affiliations

  • Martin K. Schilling
    • 1
    Email author
  • Martin Eichenberger
    • 1
  • Christoph A. Maurer
    • 1
  • Richard Greiner
    • 2
  • Peter Zbären
    • 3
  • Markus W. Büchler
    • 1
  1. 1.Department of Visceral and Transplant SurgeryUniversity of Bern, InselspitalBernSwitzerland
  2. 2.Department of Radiation OncologyUniversity of Bern, InselspitalBernSwitzerland
  3. 3.Department of Head and Neck SurgeryUniversity of Bern, InselspitalBernSwitzerland

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