title: Palliative gastric transposition following pharyngolaryngoesophagectomy.
abstract: Extensive extirpative resection of advanced head and neck tumors followed by functional reconstruction is a formidable undertaking. Poor long-term survival and substantial morbidity and mortality have often conferred a nihilistic approach toward these patients. We reviewed our experience with transhiatal gastric transposition with pharyngogastric anastomosis for reconstruction of pharyngoesophageal defects to assess the value of undertaking such a formidable surgical intervention. A retrospective analysis (1990-1994) of 20 consecutive patients with advanced head and neck tumors who underwent pharyngolaryngoesophagectomy followed by transhiatal gastric transposition with pharyngogastric anastomosis was performed. Morbidity was 35 per cent; mortality was 10 per cent. Pharyngogastric leaks occurred in 10 per cent of patients. The median postoperative stay was 19 days. Ninety-four per cent of patients had good to excellent palliation. Follow-up averaged 14.3 months. Late stricture occurred in two patients that was easily amenable to dilatation. Tumor recurrence caused dysphagia in one patient; otherwise, all patients are swallowing well or have died without dysphagia. Gastric transposition without thoracotomy is a versatile and reliable method for reconstruction of large pharyngoesophageal defects and is associated with an acceptable morbidity and mortality, thus allowing good palliation in a patient population with an extremely poor prognosis and an otherwise poor quality of life.
authors.affiliation: Department of Surgery, Pennsylvania Hospital, Philadelphia 19106, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Azurin
authors.forename: L S
authors.initials: LS
authors.lastname: Go
authors.forename: M L
authors.initials: ML
authors.lastname: Kirkland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002291:Carcinoma, Papillary / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010166:Palliative Care; D010611:Pharyngectomy; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery; D016896:Treatment Outcome