シンポジウム １：高齢者の下咽頭，食道の生理と病態 Ｂ． 高齢者の下咽頭頚部食道癌の外科治療と再建術後の機能 とくに遊離空腸移植術

Abstract

Forty-one cases of hypopharyngeal cancer and nine cases of cervical esophageal cancer were resected and reconstructed between 1984 and 1990. “Elderly”was defined as age 65 or above in this paper. There were 21 elderly hypopharyngeal patients and 5 elderly cervical esophageal cancer patients.Surgical procedure, pathological examination, prognosis and recurrence type were compared between elderly and under 65 groups. Reconstruction procedure and functional evaluation were studied via a questionnaire on meal intake and VTR of postoperative barium swallow.Pharyngolaryngoesophagectomy was performed in all hypopharyngeal cancer cases. Radical neck dissection on the tumor side and functional dissection on the opposite side were mainly performed, while bilateral functional dissection was done in nine patients, 6 of whom were under 65.Reconstruction in cases of hypopharyngeal cancer after resection of pharynx, larynx and cervical esophagus was by free jejunal transplantation in 38 cases, by gastric tube in two and by myocutaneous flap of latissimus dorsi in one. In the elderly, eighteen cases were reconstructed by free jejunal transplantation and in 3 patients over 80 years old.Functional evaluation via questionnaire of meal intake and VTR of postoperative barium swallow revealed slightly poor results in the elderly, but reconstruction by free jejunal transplantation should be the first choice after resection of hypopharyngeal carcinoma, without establishing an age limit.