Role of Total Laryngopharyngoesophagectomy with Gastric Pull Up in the Management of Locally Advanced Hypopharyngeal Cancers.

Abstract

The current consensus in the management of hypopharyngeal cancers favors the non-surgical management. However, many studies have reported relatively better oncological and functional outcomes with the surgical approach in locallyadvanced hypopharyngeal cancers. In here, we report a tertiary care center's experience with total laryngopharyngoesophagectomy with gastric pull-up done for such cases. We also describe a slight modification of the procedure that has been followed at our institute, and discuss its advantages. It is a retrospective study of patients who have undergone the surgical procedure between the September 2016 and the March 2019. The primary objective was to analyze the surgical complications and the benefits in terms of disease clearance, survival duration, and functional outcomes. Study consisted of 15 patients, mostly men, with mean age of 56years. 12/15 had stage IV disease and 7/15 were failed chemoradiotherapy. Most common complication of surgery was anastomotic failure (33%). Perioperative mortality rate was 13.3%. Higher complicationscould probably be attributed to poor nutrition and tension over the anastomosis. Mean survival duration and disease free interval were 12.1 and 11months, respectively. Oral feeds was restored in 77%, and the average time to restore oral feedswas 17days. Most of our results were comparable with the literature, which supports the surgical excision of larynx-pharynx-esophagus and reconstruction by pull-up, in all those medically fit cases of radio-recurrent/residual tumors, andalso in primary cases oflocally advanced hypopharyngeal cancers with non-functional larynx. In these scenarios, the radicalsurgical treatment wouldatleast serve as palliative if not curative.