Problems in reconstructive surgery in the treatment of carcinoma of the hypopharyngoesophageal junction.
OBJECTIVE
Thirty percent of carcinomas of the pyriform sinus manifest generally with infiltrations in the cervical esophagus. In recent years, progress in reconstructive surgery has broadened surgical indications to include tumors previously managed with palliative measures alone. In some cases, radical surgery has been extended to creating safer resection margins, with more and more indications for circular pharyngectomy. Lesions involving the hypopharyngoesophageal junction pose particular problems; furthermore, the high rate of synchronous or metachronous tumors warrants the indication for total esophagectomy, which requires complex reconstructive techniques.


METHODS
We report on a series of 21 patients who underwent pharyngocoloplasties after receiving total pharyngolaryngoesophagectomy.


RESULTS
With regard to the oncologic results, after a follow-up of 2-60 months, 9 patients had no evidence of disease, 5 patients died during the postoperative course, 2 patients survived with disease, 4 died with disease, 1 died from metachronous breast carcinoma, and 7 underwent reintervention.


CONCLUSIONS
In cases in which reconstruction by gastric pull-up is considered risky, if not contraindicated, pharyngocoloplasty represents a particularly reliable treatment option. The limits and advantages of the technique are discussed. The procedure permitted us to reconstruct the digestive tract, without encountering problems any more serious than those a normal gastric pull-up procedure would pose.
II Otorhinolaryngology Department, University of Turin, Italy.
M
M
Bussi
V
V
Ferrero
E
E
Riontino
G
G
Gasparri
M
M
Camandona
G
G
Cortesina
D000368:Aged; D003106:Colon / Q000637:transplantation; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D010611:Pharyngectomy; D019651:Plastic Surgery Procedures / Q000379:methods*; D015996:Survival Rate