Experience in the treatment of synchronous and metachronous carcinoma of the oesophagus and the head and neck

Background and Objectives: Treatment of multiple primary squamous cell carc inomas of the head and neck and oesophagus is controversial. The poor progn osis of these 2 types of carcinoma taken individually and their anatomic pr oximity complicate the therapeutic strategy and limit the treatment choices for each location. Methods: From 1986 to 1998, 43 patients received curative treatment for mul tiple synchronous (n = 30) or metachronous (n = 13) primary neoplasms of th e oesophagus and head and neck. For synchronous cancers, the therapeutic st rategy consisted of first curing the head and neck cancer and then planning oesophagectomy according to the type of head and neck cancer therapy. Results: Ten total oesopharyngolaryngectomies and 33 subtotal oesophagectom ies were performed. The postoperative mortality rate was 9.3% (4/43). The r ate of anastomotic leakage was 30% (13/43), and all such leaks were cervica l. Pulmonary infection occurred in 19% of cases (8/43). A past history of c ervical radiation therapy or cervicotomy did not appear to be a significant risk factor for anastomotic leakage or pulmonary complications. Oesophagec tomy did not affect the functional results in the 31 patients whose larynx could be preserved. Conclusions: Oesophagectomy after head and neck cancer treatment is possibl e with a low mortality rate and acceptable morbidity. (C) 2000 Wiley-Liss, Inc.