CURRENT STATUS OF PHARYNGOLARYNGO-ESOPHAGECTOMY AND PHARYNGOGASTRIC ANASTOMOSIS

Background. Pharyngolaryngo-esophagectomy and pharyngogastric anastomo sis (PLO & PGA) is one of the surgical options in the management of tu mors arising from the hypopharynx and cervical esophagus, Indications of the operation and the outcome are changing over the years. To exami ne these, the experience of this operation in one Institute (the Head and Meek Division of the Department of Surgery, The University of Hong Kong at Queen Mary Hospital, Hong Kong) over the last 30 years was re viewed. Methods. From 1966 to 1995, a total of 317 patients underwent PLO & PGA, The clinical results of 69 patients operated on between 198 6 and 1995 were analyzed and compared with those of the two groups of patients reported previously from the same Institute to establish the current status of PLO & PGA. Results. The demographic data of three gr oups of patients were similar. In previous years, 53% of the primary t umors were advanced laryngeal carcinomas extending to the hypopharynx, whereas the other 47% originated from hypopharyngeal and cervical eso phageal regions. In recent years, ail patients belonged to the latter group. Conclusions. The hospital mortality has decreased from 31% to 9 %, and the incidence of morbidity such anastomotic leakage and bleedin g has also been reduced, from 20% to 10%. This may be related to the i ntroduction of transthoracic endoscopic mobilization of the esophagus and patient selection. The overall minor morbidity has, however, remai ned at about 49%, and the 5-year actuarial survival rate has improved, from 18% in the 1970s to 24.5% at present. (C) 1998 John Wiley & Sons , Inc.