Long‐term survival of patients with stage IV hypopharyngeal cancer: Impact of fundus rotation gastroplasty

Abstract

Abstract. Stage IV circular hypopharyngeai cancer is a disease with poor long-term survival, and the only means of cure---surgery~is associated with high morbidity. All patients admitted with circular hypopharyngeal cancer and extension to the esophagus were enrolled in a multidisciplinary treatment protocol, including circular laryngopharyngoesophagectomy with tracheostomy, neck dissection, and pull-up of a fundus rotation gastric tube that was anastomosed to the oropharynx. Five weeks postoperatively high-dose radiotherapy (60 Gy) was given to the cervical region. Altogether, 18 qualifying patients were explored cervically, were found to have resectable lesions (i.e., without carotid artery infiltration), and were included in the protocol. After laryngopharyngoesophagectomy, an elongated gastric tube was pulled up to the oropharynx. The average distance bridged with the tube was 32 ---4 cm. No anastomotic leaks were found on postoperative Gastrografin swallow, and oral feeding was started between days 5 and 8. Patients were discharged with normal oral feeding on day 21 ( -17 days). Diarrhea, postprandial fullness, and reflux resolved within 6 months postoperatively. Five patients died during the follow-up period of 42 months (range 3-63 months): three due to cardiac events 18 and 38 months postoperatively and two within 12 months with residual disease and tumor recurrence, respectively. The estimated 5-year survival was 60%. We concluded that an aggressive multidisciplinary approach including circular laryngopharyngoesophagectomy, neck dissection, and high-dose radiotherapy ascertains good long-term survival and good functional results in patients with advanced hypopharyngeai cancer when the intestinal continuity is reconstructed with a fundus rotation gastroplasty.The dismal outcome of advanced-stage hypopharyngeal cancer is determined by tumor biologic factors and late patient presentation [1,2] as well as by inconsistent treatment strategies [3][4][5][6]. Although oncologic aspects require a circular laryngopharyngectomy [7] and postoperative irradiation [4,8], the short life expectancy of these patients mandates the acknowledgment of palliative aspects such as their swallowing capability and overall quality of life. The difficult reconstructive procedure after circular laryngopharyngoesophagectomy has been approached with a total gastric pull-up by Ong and Lee [9]. Their procedure, however, was not favored by many Western surgeons owing to the high anastomotic

Early and long-term morbidity after total laryngopharyngectomy

“…These data are rarely reported in the literature, but Oniscu et al [22] reported satisfactory swallowing of 78% after 6 months and 81% after 12 months, suggesting that a rehabilitation period of 2 months should on average be expected. An interesting alternative reconstruction technique was introduced by Schilling et al [23] who described the use of a fundus rotation gastroplasty resulting in a low complication rate and moderate dysphagia during the first 6 months after surgery which resolved within 1 year. Patients undergoing total laryngopharyngectomy are generally patients with advanced disease, roughly 75% having stages III or IV disease.…”

Functional Long-Term Outcome of a Free Jejunal Transplant Reconstruction following Chemoradiotherapy and Radical Resection for Hypopharyngeal and Proximal Oesophageal Carcinoma

“…Using preoperative radiotherapy followed by a similar surgical technique as in the present study, Oniscu et al [12] found a 1- and 3-year survival of 52 and 33% respectively in 20 consecutive patients with hypopharyngeal carcinoma. In addition, Shilling et al [9] recently reported a 3- and 5-year survival of 72 and 60% respectively after surgical resection, fundus rotation gastroplasty and early postoperative radiation in 18 patients with hypopharyngeal carcinoma.…”

“…Two-stage operations such as the deltopectoral flap technique, colon interposition, reversed gastric tubes, local and regional skin flaps have to a large extent been replaced by one-stage procedures such as gastric pull-up or reconstruction with free fasciocutaneus microvascular transplants [2,3,4,5,6,7,8,9,10,11]. The use of free jejunal transplants has been popularized during the last decades and advocated by many surgeons [12,13,14,15,16,17,18].…”

Translationale Forschung bei Kopf-Hals-Tumoren

“…Grundlage dieser Untersuchung war die publizierte exorbitant gute Überlebensrate (60%) nach Laryngoöso-phagektomien mit konsekutiver Magenhochzugs-Op. bei T4b-Hypopharynxkarzinomen [46]. Erfahrungsgemäß ist die 5-Jahres-Überlebensrate dieser Tumoren < 25% und konnte durch die konsequente Entfernung des gesamten Öso-phagus deutlich verbessert werden.…”