Pharyngolaryngoesophagectomy with Gastric Transposition Reconstruction: Comparison of Single Institution Outcomes from 1965 to Today

Abstract

Objectives: 1) Comparison of our current operative and functional outcomes with those published previously from our institution for pharyngolaryngoesophagectomy (PLO) with gastric transposition reconstruction. 2) Analysis of the role of this reconstructive option in contemporary head and neck surgery. Methods: Retrospective review of patients who underwent PLO with gastric transposition and feeding jejunostomy from 2010 to 2013. Comparison was made with previously published data from our institution dating back to 1965 for the same procedure, and with more recent literature reports. Results: Nine patients were identified: 3 had primary T4 squamous cell carcinoma, 3 had local recurrence from radical radiotherapy, and 3 had previously treated metastatic tumor. There was no in-hospital mortality. Early complications occurred in 44% including salivary fistula (n = 1). Average length of stay was 36.4 days. 1 patient had local recurrence at 6 months. Disease free survival was 89% at last follow up (range 1-28 months). Method of communication at 12 months included esophageal speech, electrolarynx and voice prosthesis. Time to jejunostomy removal was 2-16 months. Conclusions: The in-hospital mortality rate of zero in this series compares with rates of 7-12% previously in our institution. However our contemporary morbidity rates are higher than the 8% and 29% previously reported, which may reflect our 67% rate of salvage surgery and exclusively T4 or metastatic caseload. Our complication rates are comparable with those published in the last decade for both gastric transposition and free tissue transfer reconstruction and highlights that gastric transposition is an effective reconstruction option in these advanced tumors.