Strategies of surgery treatment for cervical esophageal cancer

Abstract

To explore the methods and means of surgical treatment for cervical esophageal cancer in order to get the best efficacy. Retrospective investigation and analysis were carried out in 137 patients with cervical esophageal cancer undergoing operation in our hospital from January 2005 to December 2013. According to lesion locations, these cases were divided into two groups: larynx preservation group(Group A) and laryngectomy group(Group B). Surgery options of Group A included inversion esophagectomy without thoracotomy, three-incision esophagectomy, end to end anastomosis of cervical esophagus after local resection. Group B included gastric-pharyngeal anastomosis, pharyn-esophagus plasty, colon replacement of the esophagus or jejunal interposition. All the patients received postoperative adjuvant therapy. There were no perioperative deaths. The main postoperative complications included anastomotic fistula in 20 cases(14.6%), postoperative massive bleeding after inversion esophagectomy in 3 cases, chylothorax in 1 case, anastomotic stenosis in 9 cases, severe gastroesophageal reflux in 6 cases and serious aspiration pneumonia in 2 cases. All these patients had complete resolution of disease with good postoperative quality of life. The 1-year, 3-year and 5-year survival were 73.7%, 48.4% and 26.8% respectively. The most important causes of postoperative death included local recurrence, cervical or mediastinal lymph node metastases, cachexia and multiple organic metastasis. It is critical to select reasonable methods of operations to reduce postoperative complications and to receive proper adjuvant therapy.