Mortality and morbidity of primary pharyngogastric anastomosis following circumferential excision for hypopharyngeal malignancies

Abstract

Seventy-five patients underwent gastric transposition for replacement of the pharyngoesophagus. These patients had primary or recurrent malignant tumors of the hypopharynx, postcricoid region, and cervical esophagus. The operative procedure consisted of a transhiatal esophagectomy and gastric pull-up to establish gastrointestinal continuity, with a unilateral or bilateral neck dissection where indicated. Seven patients died, a mortality rate of 9.33%. The average hospital stay of uncomplicated cases was 18 days and for complicated cases was 40 days. Immediate restoration of oral intake was achieved in 70.6% of patients. We conclude that gastric transposition after circumferential laryngopharyngeal excision is a procedure with low mortality and acceptable morbidity leading to early relief of dysphagia.

Gastric Pull-up Reconstruction for Pharyngo-laryngo-esophagectomy

“…Our results compare favorably with those of other reports of gastric pull-up reconstruction. 23 They also are comparable to re¬ sults of recent reports comparing free jejunal transfer with gastric pull-up operations.24,25 Gastric pull-up has the ad¬ vantage of being a one-stage operation that uses two teams of surgeons and one intestinal anastomosis. The stom¬ ach has an excellent blood supply, there are no vascular anastomoses, the stomach is a mucosal-lined structure, and there is a low incidence of fistula and stricture for¬ mation.…”

Current status of pharyngolaryngo-esophagectomy and pharyngogastric anastomosis

“…This was also the experience in other centers. [12][13][14] This change of indication accounts for the low incidence of PLO & PGA in recent years, although the overall surgical volume remained similar.…”

Circumferential pharyngeal reconstruction: History, critical analysis of techniques, and current therapeutic recommendations

“…A literature review of all large series (more than 50 cases) of gastric transposition comprises a total of 546 cases and the following overall complication rates: perioperative mortality, 9%; perioperative morbidity, 44%; and fistula rate, 14% (Table 1). 10, 11, 23–26 Functional results were rarely recorded in these series. Recent modifications of gastric transposition surgery include combined laparoscopic and thoracoscopic esophagogastric mobilization, thereby avoiding the morbidity of laparotomy and thoracotomy 27.…”