Problems in reconstructive surgery in the treatment of carcinoma of the hypopharyngoesophageal junction

Background and Objectives: Thirty percent of carcinomas of the pyriform sin us manifest generally with infiltrations in the cervical esophagus. In rece nt years, progress in reconstructive surgery has broadened surgical indicat ions to include tumors previously managed with palliative measures alone. I n some cases, radical surgery has been extended to creating safer resection margins, with more and more indications for circular pharyngectomy. Lesion s involving the hypopharyngoesophageal junction pose particular problems; f urthermore, the high rate of synchronous or metachronous tumors warrants th e indication for total esophagectomy, which requires complex reconstructive techniques. Methods: We report on a series of 21 patients who underwent pharyngocolopla sties after receiving total pharyngolaryngoesophagectomy. Results: With regard to the oncologic results, after a follow-up of 2-60 mo nths, 9 patients had no evidence of disease, 5 patients died during the pos toperative course, 2 patients survived with disease, 4 died with disease, 1 died from metachronous breast carcinoma, and 7 underwent reintervention. Conclusions: In cases in which reconstruction by gastric pull-up is conside red risky, if not contraindicated, pharyngocoloplasty represents a particul arly reliable treatment option. The limits and advantages of the technique are discussed. The procedure permitted us to reconstruct the digestive trac t, without encountering problems any more serious than those a normal gastr ic pull-up procedure would pose. J. Surg. Oncol. 2000;74:130-133. (C) 2000 Wiley-Liss, Inc.