Primary carcinoma of the hypopharynx and cervical esophagus: evolution of surgical therapy.
Carcinoma of the cervical esophagus is invariably fatal because of its advanced stage at presentation. In our surgical division, 167 patients with primary squamous-cell carcinoma of the cervical esophagus were treated over the period between 1973 and June 1992. The tumor was localized in the cervical esophagus in only 37 cases, whereas it also involved the hypopharynx in 112 patients or extended to the cervico-thoracic segment in the remaining 18 subjects. Ninety-three patients underwent surgery (operability rate: 55.6%), and in 68 of these the tumor was resected (resectability rate: 73.1%). Over the 20-year study period, surgical techniques have evolved as a result of the experience gained with previous surgical therapies. Six of the 68 resected patients died (8.8%). Ten patients undergoing surgical resection subsequently presented with local recurrence: 3 after cervical esophagectomy (25%) and 7 after total esophagectomy (12.5%). Moreover, six patients treated by radical resection without laryngectomy had recurrent tumor (46.1%). The cumulative 5-year survival rate was 16.6%. The experience accumulated over the years suggests that the procedure of choice is laryngopharyngo-(total)-esophagectomy without thoracotomy, with gastric pull-up for reconstruction of the digestive tract. The other surgical procedures, in our experience as well in that of other authors, are associated with a higher incidence of relapse and a decreased survival rate. In an attempt to improve on the disappointing long-term results, we introduced a preoperative course of chemotherapy and radiotherapy in the management of the last 6 patients in our series.(ABSTRACT TRUNCATED AT 250 WORDS)
Laterza
E
E
1st Division of General Surgery, University of Verona, Italy.
Mosciaro
O
O
Urso
U S
US
Inaspettato
G
G
Cordiano
C
C
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D015994:Incidence; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009333:Neck; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D010611:Pharyngectomy; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors