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Surgical treatment of hypopharyngeal and cervical esophageal cancer

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Abstract

Numerous methods have been employed for esophageal replacement after total pharyngolaryngectomy-esophagectomy. These have included the use of skin, as well as free transplantation or transposition of various abdominal viscera. The history and technical aspects of the procedures that have been used on the author's service are reviewed and results of 32 reconstructive operations are presented. Lower mortality and morbidity rates were obtained and palliation more consistently achieved with visceral transposition procedures than when the esophagus was reconstructed with skin. The 3-year cure rate of patients undergoing resection for cancer was 21%. Gastric transposition after extrathoracic total esophagectomy is the preferred procedure for suitable patients with post-cricoid and cervical esophageal carcinoma. Skin flaps are preferred for high hypopharyngeal tumors and in the poorest risk patients. Reversed gastric tube esophagoplasty and esophagocoloplasty are best employed for secondary rather than primary reconstruction.

Résumé

De nombreuses techniques ont été proposées pour remplacer l'oesophage après pharyngo-laryngo-oesophagectomie totale: elles utilisent la peau ou des transpositions de divers viscères abdominaux. L'article revoit l'histoire des techniques utilisées dans le service et présente les résultats obtenus dans 32 reconstructions. La transposition de viscères donne une mortalité et une morbidité plus faibles et une palliation meilleure que la reconstruction utilisant la peau. La survie à 3 ans est de 21% après résection pour cancer. Chez les malades atteints de cancer de l'oesophage sous-cricoÏdien ou cervical, la gastroplastie après oesophagectomie totale extrathoracique est la technique de choix, si l'état du malade le permet. Pour les tumeurs hautes, sous-pharyngées, et dans les cas à haut risque, nous préférons les lambeaux cutanés. Le tube gastrique inversé et la plastie avec le cÔlon sont utilisés pour les reconstructions secondaires plutÔt que pour les primaires.

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  1. The Combined Head and Neck Service, Departments of Surgery and Otolaryngology, Montefiore Hospital and Medical Center, The Albert Einstein College of Medicine, Bronx, New York, USA

    Carl E. Silver M.D.

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Silver, C.E. Surgical treatment of hypopharyngeal and cervical esophageal cancer. World J. Surg. 5, 499–507 (1981). https://doi.org/10.1007/BF01655002

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