Risk factors for complications after pharyngolaryngectomy with total esophagectomy.

Eisuke Booka,Yuko Kitagawa,Atsushi Imai,Yoshiyuki Iida,Takashi Kitani,Katsushi Takebayashi,Yasuhiro Tsubosa,Tetsuro Onitsuka,Masahiro Nakagawa,Wataru Takagi,Ayako Shimada,Masahiro Niihara,Hiroya Takeuchi,Masato Nagaoka,Tomoyuki Kamijo

doi:10.1007/s10388-016-0533-9

Abstract

BackgroundPharyngolaryngectomy with total esophagectomy (PLTE) is an effective surgical treatment for synchronous or metachronous hypopharyngeal or laryngeal cancer and thoracic esophageal cancer, although it is more invasive than esophagectomy and total pharyngolaryngectomy. The aim of this study was to identify risk factors for complications after PLTE.MethodsFrom November 2002 to December 2014, a total of 8 patients underwent PLTE at the Shizuoka Cancer Center Hospital, Shizuoka, Japan. We investigated the clinicopathological characteristics, surgical procedures, and postoperative complications of these patients.ResultsOf the 8 patients, 5 underwent one-stage PLTE and 3 underwent staged PLTE. There was no mortality in this study. Two cases of tracheal necrosis, two of anastomotic leakage, and one of ileus were observed as postoperative complications. Two patients who underwent one-stage PLTE with standard mediastinal lymph node dissection developed tracheal necrosis and severe anastomotic leakage.ConclusionOne-stage PLTE and standard mediastinal lymph node dissection were identified as the risk factors for severe postoperative complications. Staged PLTE or transhiatal esophagectomy should be considered when PLTE is performed and standard mediastinal lymph node dissection should be avoided when one-stage PLTE is performed with transthoracic esophagectomy.

Highlights

Esophageal cancer is the sixth leading cause of cancerrelated mortality worldwide because of its high malignant potential and poor prognosis [1]
One-stage Pharyngolaryngectomy with total esophagectomy (PLTE) and standard mediastinal lymph node dissection were identified as the risk factors for severe postoperative complications
Staged PLTE or transhiatal esophagectomy should be considered when PLTE is performed and standard mediastinal lymph node dissection should be avoided when one-stage PLTE is performed with transthoracic esophagectomy

Summary

Introduction

Esophageal cancer is the sixth leading cause of cancerrelated mortality worldwide because of its high malignant potential and poor prognosis [1]. Esophagectomy is a highly invasive procedure associated with several serious postoperative complications such as pneumonia, anastomotic leakage, and recurrent laryngeal nerve paralysis, which may result in multiorgan failure [4]. Another clinical problem associated with esophageal cancer is its frequent association with synchronous or metachronous gastric or head and neck cancer [5]. Pharyngolaryngectomy with total esophagectomy (PLTE) is an effective surgical treatment for synchronous or metachronous hypopharyngeal or laryngeal cancer and thoracic esophageal cancer, it is more invasive than esophagectomy and total pharyngolaryngectomy. Two patients who underwent one-stage PLTE with standard mediastinal lymph node dissection developed tracheal necrosis and severe anastomotic leakage

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