Surgical management of carcinoma of the hypopharynx and cervical esophagus- Analysis of 209 cases

Background: Free jejunal transfer has become the standard technique for rec onstruction of the pharynx and hypopharynx, especially with proximal neopla stic lesions, whereas gastric tube interposition is the technique of choice for reconstruction of the hypopharynx and cervical esophagus when resectio n extends below the thoracic inlet. Hypothesis: Surgical ablation is a viable option for advanced hypopharyngea l and cervical esophageal neoplasms, with stomach interposition a safe and preferred method of reconstruction. Design: Retrospective analysis. Setting: University hospital that is a regional referral institution for es ophageal cancer treatment and complex digestive reconstructions after esoph agectomy. Patients: We reviewed the records of 209 patients who underwent total phary ngolaryngectomy between May 1982 and July 1999. The majority of patients ha d advanced cancer: hypopharyngeal in 131 cases and cervical esophageal in 7 8 cases. Interventions: Pharyngolaryngectomy and total esophagectomy with pharyngoga stric anastomoses (n = 127); pharyngolaryngectomy, cervical esophagectomy, and reconstruction with free jejunal transplant (n = 77); and pharyngolaryn gectomy and total esophagectomy with pharyngocolic anastomoses (n = 5). Main Outcome Measures: Postoperative mortality and morbidity, long-term sur vival, and prognostic factors influencing survival. Results: The postoperative in-hospital mortality rate was 4.8% (10 patients ), with a postoperative morbidity rate of 38.3%. Alimentary continuity was achieved using the stomach (127 patients), colon (5 patients), or free jeju nal autograft (77 patients). The 1-year and 5-year survival rates were 62% and 24%, respectively. There was no significant difference with regard to t he survival between gastric transposition and free jejunal autograft, but t here were fewer complications in the gastric pull-up group (33% vs 47%, P < .05). The significant adverse factors affecting survival were tumor cervic al localization, postoperative complications, disease stages pT3 and pT4 fo r the cervical esophageal tumors, microscopic pharyngeal penetration, or in complete resection. The significant beneficial factors were tumor hypophary ngeal localization and postoperative radiotherapy. Conclusions: Surgical ablation is a viable option for advanced hypopharynge al and cervical esophageal neoplasms, with stomach interposition the prefer red method of reconstruction. Although the prognosis is poor, satisfactory short-term palliation can be achieved. The significant adverse factors affe cting survival should be taken into account to select the candidates for su rgery.