Functional outcome and survival after pharyngolaryngoesophagectomy for cancer

BACKGROUND: Surgical resection of the larynx, hypopharynx and cervical esop hagus, or pharyngolaryngoesophagectomy (PLE), with pharyngogastric anastomo sis (PGA) offers a means of controlling local and regional carcinoma of the upper aerodigestive tract (UADT). We reviewed our experience with PLE for carcinoma of the UADT to evaluate functional outcome and survival. METHODS: Patients undergoing PLE from 1986 through 1999 were reviewed. Surv ivors completed questionnaires which graded their level of function and voi ce rehabilitation. Gastric emptying studies were performed with rates compa red with normal controls. Survival curves were generated using the Kaplan-M eier method. RESULTS: Thirty-one patients underwent PLE during the study period. Twenty- nine patients had squamous cell carcinoma. Operative mortality was 0%. Thir ty-day mortality was 9.6%. There were 2 anastomotic leaks (6.4%). All survi vors reported normal ability to complete activities of daily living. Voice rehabilitation was acceptable in 7 of 10 survivors. Positive surgical margi ns resulted in decreased survival (P = 0.03). No other patient demographic or management variable altered survival. One-year, 5-year, and 10-year surv ival rates were 67%, 40%, and 18%, respectively. CONCLUSIONS: PLE with PGA for carcinoma of the UADT may be performed with l ow morbidity and mortality. Functional patient outcomes including gastric e mptying, activities of daily living, and voice rehabilitation are acceptabl e. (C) 2001 by Excerpta Medica, Inc.