Improved Method of Reconstruction after Laryngo-Pharyngo-Esophagectomy for Squamous Cell Carcinoma of Pharyngo-Esophageal Junction or Synchronous Hypopharyngeal and Esophageal Cancer

Abstract

Background: In this study, the advantages of a newly developed method of reconstruction following laryngo-pharyngo-esophagectomy were confirmed in patients with squamous cell carcinoma originating from the pharyngo-esophageal junction or with synchronously developed cancers of the hypopharynx and esophagus. Methods: Between 2003 and 2014, 11 patients underwent laryngo-pharyngo-esophagectomy at our institution. Eight patients had cancers simultaneously involving both the hypopharynx and the esophagus, two had carcinoma at the pharyngo-esophageal junction, and one had synchronously developed cancers of the hypopharynx, esophagus, and stomach. The prognosis and quality of life of these 11 patients were analyzed retrospectively, to establish the utility of a newly developed, improved (supercharged) method of reconstruction. Results:The mean operation time was 990 min (range: 635-1,320 min) and mean intraoperative blood loss was 1,236 ml (range: 240–2,500 ml). Operative morbidity, mortality, and 5-year survival rate were 45.5%, 9.1%, and 45.5%, respectively. Four patients underwent a traditional end-to-end anastomosis of the nasopharynx with the gastric tube. In all four patients, necrosis of the distal end of the gastric tube necessitated a skin flap reconstruction. One patient died from this complication. The supercharge method of reconstruction was performed in seven patients: in two using a reversed gastric tube, in four with a free jejunal graft, and in one with an ileocolic graft. None of these patients developed anastomotic leakage. Conclusion:The supercharged method yields improved reconstruction results in patients requiring laryngo-pharyngo-esophagectomy. Among the advantages of this method is better quality of life for these patients.