Carcinoma of the hypopharynx and the cervical oesophagus: a surgical challenge

Objective: To report our results after reconstruction of the upper digestiv e tract for locally advanced carcinoma of the hypopharynx and cervical oeso phagus. Design: Open study. Setting: Teaching University hospital, Germany. Subjects: Of the 517 patients who presented with carcinoma of the oesophagu s between September 1985 and March 1997, 16 had a locally advanced tumour o f the hypopharynx and 25 of the cervical oesophagus. Intentions: Free jejunal grafts were used after circular resection in all p atients with carcinoma of the hypopharynx, and for the 3 with oesophageal c arcinoma in whom we obtained adequate resection margins. In the remainder s tomach was used in 21 and colon in 1. Main outcome measures: Morbidity and mortality. Results: After jejunal grafting 1 patient died within 30 days and 2 died in hospital. After gastric or colonic reconstruction 2 patients died within 3 0 days and 4 in hospital. There was 1 anastomotic leak, 1 transplant became necrotic and had to be replaced, in 2 patients the recurrent nerve was dam aged, 1 patient developed a wound infection and 1 a cardiac infarction. Aft er gastric or colonic replacement 7 patients had paralysed recurrent laryng eal nerves, there was 6 anastomotic leaks, 1 chylous leak.1 haemorrhage, an d in 1 the transplant necrosed. Conclusion: Despite the fact that we compared tumours in different sites, t hese results suggest that the jejunal graft is safer for upper oesophageal and hypopharyngeal reconstruction.