473. SAFETY AND USEFULNESS OF LARYNX- PRESERVING HIGH-LEVEL CERVICAL ANASTOMOSIS FOR CERVICAL ESOPHAGEAL CANCER

Abstract

Abstract In cases of cervical esophageal cancer, total Pharyngo-Laryngo-Esophagectomy is often performed when the oral edge of the primary tumor is less than 2 cm from the esophageal entrance. In our hospital, we provide neo-adjuvant chemotherapy for cervical esophageal cancer and perform larynx-preserving esophagectomy whenever possible. The aim of this study was to evaluate the safety and efficacy of larynx- preserving high-level cervical anastomosis for cervical esophageal cancer. 41 patients underwent larynx- preserving esophagectomy for cervicothoracic esophageal cancer between January 2009 and September 2021 at our hospital were included. The distance from the oral edge of the primary tumor to the esophageal entrance was measured by esophagography and endoscopy. Patients with the distance of 2 cm or less were classified as the high cervical anastomosis group (H group: n=23), and patients with the distance of 2.1 cm or more were classified as the low cervical anastomosis group (L group: n=18). We compared the short-term and long-term results between the H and L groups. There were no differences between H and L groups in terms of patient characteristics, such as clinical depth of tumor invasion, grading of lymph node metastasis, frequency neo-adjuvant chemotherapy. The incidence of postoperative complications was similar in the two groups such as pneumonia, anastomotic leakage, anastomotic stenosis, recurrent nerve palsy. In histopathological examination, the rate of positive proximal resection margin was significantly higher in H group. (34.8 vs 5.6%(P=0.028). 3-year recurrence-free survival rate and 3-year survival rate were similar in the two groups. The anastomotic recurrence rates did not differ between the two groups. (5.0 vs 5.9% (P=0.715)) In the H group, the rate of positive proximal resection margin was significantly higher. However, there was no difference in the anastomotic recurrence rate and the 3-year survival rate between the two groups. Therefore, we believe that larynx- preserving high-level cervical anastomosis is useful to maintain QOL in cervical esophageal cancer patients with the oral edge of the primary tumor is less than 2 cm from the esophageal entrance.