Investigation of Pharyngo-laryngectomy with Total Esophagectomy as Salvage Surgery for Recurrent or Residual Cancer after Radiotherapy

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  • Torii Junichi
    Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Shimbashi Wataru
    Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Mitani Hiroki
    Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Watanabe Masayuki
    Department of Esophageal Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Imamura Yu
    Department of Esophageal Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Okamura Akihiko
    Department of Esophageal Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Seto Akira
    Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Kamiyama Ryosuke
    Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Tokashiki Kunihiko
    Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research
  • Kawabata Kazuyoshi
    Department of Head and Neck Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research

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Other Title
  • 放射線治療後の遺残・再発例に対する咽喉頭全摘・食道全摘症例の検討
  • ホウシャセン チリョウ ゴ ノ イザン ・ サイハツレイ ニ タイスル インコウトウ ゼンテキ ・ ショクドウ ゼンテキショウレイ ノ ケントウ

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Abstract

<p>Hypopharyngeal and esophageal cancers frequently overlap. Some patients want to undergo radiotherapy as the first treatment, even if they have the option of undergoing radical surgery. When the disease remains or recurs after radiotherapy, pharyngo-laryngectomy with total esophagectomy (PLTE) is sometimes indicated. We retrospectively examined surgical procedures and postoperative complications in 7 patients who underwent post-RT PLTE at our hospital from April 2007 to October 2017. We also compared results with those from fresh cases who underwent PLTE as first-line treatment. Partial thoracic excisions were performed in 4 cases, tracheostomaplasties with pedicled flap were performed in 5 cases, and brachiocephalic trunk displacements were performed in 3 cases. Postoperative complications were observed in 5 cases. Clavien-Dindo classification was Grade IIIa or higher in 3 cases, and tracheal necrosis was present in 2 cases. Reoperations were performed for both cases of tracheal necrosis. One patient was discharged 42 days after the re-operation, but the other died after bleeding from the brachiocephalic artery after the re-operation. Excluding this case with lethal complications, median duration of hospitalization was 50 days (range, 39-74 days). On discharge from hospital, 5 cases achieved total oral diet and 1 remained tube-dependent. Post-RT PLTE is a highly invasive procedure that can cause serious complications. However, because surgery is the only possibility of curative treatment, we believe it is a procedure that can be selected with careful consideration to the specific case.</p>

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