[Pharyngoesophageal stenosis following surgery and radiotherapy in patients with advanced laryngeal cancer].
OBJECTIVE
Our objectives were to 1) know the frequency of pharyngoesophageal stenosis in patients with clinical stage III transglottic laryngeal cancer (LCa Stage III) post-surgery and radiotherapy, and to 2) describe clinical, radiologic, and endoscopic characteristics of pharyngeal-esophageal stenoses and response to dilations.


METHODS
We conducted a series of consecutive cases from 1997-2000 at the National Cancer Institute (INCan) in Mexico City and included patients with transglottic (LCa Stage III) post-surgery and -radiotherapy. We evaluated dysphagia and stenosis (length, diameter, and localization) by radiology and endoscopy before and after surgery and radiotherapy. Statistical method was descriptive.


RESULTS
Sixty five of 197 cases (33%) with laryngeal cancer were transglottic and 52 (26.3%) were clinical stage III. Patients were treated with total laryngectomy and pharyngo-esophageal "Y" stent and post-operative radiotherapy with average 7,000 cGy total dose. Thirteen patients (25%) presented pharyngo-esophageal stenosis. There was no pre-operative dysphagia; dysphagia was present in five patients post-surgery and in all after radiotherapy. In all cases, stenoses were simple and were treated with Savary Guillard-guided endoscopic dilation with an average of five sessions. Five of 13 patients (38.5%) had persistent dysphagia: two due to fibrosis, two due to loco-regional recurrences, and one due to recurrence in pharyngo-esophageal closure.


CONCLUSIONS
A total of 197 cases of laryngeal cancer were present during this period; 33% were transglottic, the majority in clinical stage III. Global frequency of stenosis was 25%; all cases were simple. Endoscopic dilations were useful in absence of fibrosis, extrinsic compression, and tumor recurrence.
Rosales Solís
Ana Alicia
AA
Servicio de Endoscopia, Instituto Nacional de Cancerología, México, D.F.
Hernández-Guerrero
Angélica
A
Sobrino Cossío
Sergio
S
Frías Medívil
Mauricio
M
Córdova Pluma
Víctor Huggo
VH
Granados García
Martín
M
Herrera Gómez
Angel
A
D000368:Aged; D003251:Constriction, Pathologic; D004940:Esophageal Stenosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D010608:Pharyngeal Diseases / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies