[Total pharyngolaryngoesophagectomy. Indications and results apropos of 17 cases].
Pharyngolaryngoesophagectomy (PLO) allows one-stage treatment of synchronous tumors involving both esophagus and hypopharynx and may also be advocated when the pharyngo-esophageal junction (PEJ) is involved. Less radical surgery may be advocated in the case of hypopharyngeal malignancy sparing the pharyngoesophageal junction. The authors report the results of 17 PLO carried out in 11 cases for a tumor involving the PEJ, and in 4 cases for synchronous tumors involving esophagus and hypopharynx. In 2 instances, PLO was performed for primary hypopharyngeal malignancy requiring total circular excision (i.e. which did not involve the PEJ). Five patients had previously received chemotherapy and 6 had had an association of chemotherapy and radiation therapy as initial treatment before surgery. Reconstructive procedure used the stomach and colon in 12 and 5 cases respectively. Hospital mortality was 4 cases out of 17. There was 1 cervical fistula secondary to pharyngogastric anastomosis necrosis. One and 2 year actuarial survival rates were 73% and 37%. Tumor recurrence and a remote new tumor were noted in 6 and 4 cases respectively, despite extensive surgical procedures and the use of chemotherapy and/or radiotherapy. When esophagectomy was added to total circular excision in case of hypopharyngeal tumor sparing the PEJ, no significant benefit was noted. Good functional results obtained by means of PLO shall lead to therapeutic trials including surgery, chemotherapy and radiotherapy with the aim of improving long-term results.
Borie
D
D
Service de Chirurgie Digestive, Hôpital Saint-Antoine, Paris.
Hannoun
L
L
Tiret
E
E
Chabolle
F
F
Nordlinger
B
B
Frileux
P
P
Parc
R
R
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D016629:Esophagectomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D007825:Laryngectomy / Q000379:methods*; D007890:Leiomyosarcoma / Q000150:complications / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010611:Pharyngectomy / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care
L'oesopharyngolaryngectomie totale. Indications et résultats à propos de dix-sept cas.