Early and long-term morbidity after minimally invasive total laryngo-pharyngo-esophagectomy with gastric pull-up reconstruction via thoracoscopy, laparoscopy and cervical incision

Abstract

Total laryngo-pharyngo-esophagectomy (TLPE) with gastric pull-up reconstruction is still considered to be associated with major complications and a significant risk of in-hospital death. Minimally invasive esophagectomy, avoiding thoracotomy and laparotomy, has been increasingly performed for esophageal malignancies with the hope of reducing mortality and morbidity, such as pulmonary complications. The aim in this study was to assess early and long-term morbidity as well as treatment outcomes in patients treated with TLPE with gastric pull-up reconstruction via thoracoscopy, laparoscopy and cervical incision. From 2004 to 2013, 10 patients with a median age of 64 years (range 47-71 years) underwent minimally invasive TPLE with gastric pull-up reconstruction. Seven of the 10 patients had previously received radiotherapy. As for early postoperative complications, no patient died during the early postoperative period, and pneumonia was observed in 1, skin necrosis in 1, pseudomembranous enterocolitis in 1, arrhythmia in 2, hemorrhage in the neck in 2, anastomotic leakage in the neck in 3, and tracheal necrosis in 6 patients. Three patients developed tracheostomal stenosis as a long-term postoperative complication, and an anastomotic stricture was observed in one patient. All patients were able to achieve oral intake, but 3 patients required feeding tube support. In conclusion, postoperative systemic complications during the early postoperative period were considered to be acceptable, although wound complications such as tracheal necrosis and anastomotic leakage were commonly observed. Therefore, this minimally invasive procedure might help reduce mortality and morbidity in patients requiring TLPE with gastric pull-up reconstruction

Risk factors for complications after pharyngolaryngectomy with total esophagectomy

“…In these 2 patients, insertion of a tracheostomy tube was effective to improve tracheal stenosis. In cases in which tracheal stenosis cannot be avoided when tracheal necrosis improves, a tracheostomy tube should be inserted to treat tracheal stenosis [ 18 ].…”

Esophageal reconstruction after oncological total laryngopharyngoesophagectomy: Algorithmic approach

“…19 The free jejunal flap has many anatomical and physiological advantages in pharyngoesophageal reconstruction and is useful to bridge the gap between the gastric tube and the oropharynx. 19 Since Asamura et al 20 reported the first combined GP and a doubly looped free jejunal flap in a patient with synchronous double cancers, the literature 6,9,12,[20][21][22][23][24] has reported that 22 patients underwent a combined GP and free jejunal flap reconstruction. Three of them had an anastomotic fistula.…”

Long-Term Survival Outcomes and Comparison of Different Treatment Modalities for Stage I-III Cervical Esophageal Carcinoma

“…Long-term survival analysis further indicated that compared with the OS results obtained with data from 1980 to 1999, a significant improvement was observed in CEC patients who underwent minimally invasive surgery from 2000 to 2013 (71.5 vs. 40.7%, P = 0.003). Other minimally invasive approaches, including total PLE ( 31 ), larynx-preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery ( 32 ) and larynx-preserving surgery ( 33 ), were also attempted, and satisfactory 2-year OS rates of 64.3, 71.5, and 50.6%, respectively, were achieved. In addition, primary RT and surgery have been directly compared in a large retrospective study ( 34 ).…”