Functional outcome and survival after pharyngolaryngoesophagectomy for cancer.
BACKGROUND
Surgical resection of the larynx, hypopharynx and cervical esophagus, or pharyngolaryngoesophagectomy (PLE), with pharyngogastric anastomosis (PGA) offers a means of controlling local and regional carcinoma of the upper aerodigestive tract (UADT). We reviewed our experience with PLE for carcinoma of the UADT to evaluate functional outcome and survival.


METHODS
Patients undergoing PLE from 1986 through 1999 were reviewed. Survivors completed questionnaires which graded their level of function and voice rehabilitation. Gastric emptying studies were performed with rates compared with normal controls. Survival curves were generated using the Kaplan-Meier method.


RESULTS
Thirty-one patients underwent PLE during the study period. Twenty-nine patients had squamous cell carcinoma. Operative mortality was 0%. Thirty-day mortality was 9.6%. There were 2 anastomotic leaks (6.4%). All survivors reported normal ability to complete activities of daily living. Voice rehabilitation was acceptable in 7 of 10 survivors. Positive surgical margins resulted in decreased survival (P = 0.03). No other patient demographic or management variable altered survival. One-year, 5-year, and 10-year survival rates were 67%, 40%, and 18%, respectively.


CONCLUSIONS
PLE with PGA for carcinoma of the UADT may be performed with low morbidity and mortality. Functional patient outcomes including gastric emptying, activities of daily living, and voice rehabilitation are acceptable.
Affleck
D G
DG
Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
Karwande
S V
SV
Bull
D A
DA
Haller
J R
JR
Stringham
J C
JC
Davis
R K
RK
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery; D005260:Female; D005746:Gastric Emptying; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016019:Survival Analysis