title: A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction.
abstract: BACKGROUND
  Squamous cell carcinoma (SCC) in the pharyngoesophageal junction (PEJ) with concomitant involvement of both the hypopharynx and cervical esophagus occurs rarely and poses a challenge in treatment. Data regarding the long-term result of aggressive surgical management was lacking.
  
  
  METHODS
  Forty-one consecutive patients were treated with total pharyngolaryngo-esophagectomy (PLE) and reconstruction between 1984 and 2002. The clinicopathological parameters and prognostic data were analyzed.
  
  
  RESULTS
  The surgery carried a postoperative mortality rate of 9.8%. The overall median survival was 18.5 months, with a 31.5% 5-year survival rate. By multivariate analysis, patients with major tumor localization in the hypopharynx had significantly favorable prognosis (median survivals for hypopharyngeal versus esophageal localization, 37.2 versus 7.1 months, P = 0.043). The administration of adjuvant radiotherapy and tumor size less than 5 cm also contributed to a better outcome (P = 0.001 and P = 0.037, respectively).
  
  
  CONCLUSIONS
  An aggressive surgical approach with total PLE in conjunction with adjuvant radiotherapy represents a feasible option for treatment of advanced SCC simultaneously involving the hypopharynx and cervical esophagus, given the major tumor localization in the hypopharynx. On the other hand, radical surgery for those with major esophageal localization or with tumor size larger than 5 cm yielded ominous results and warrants further justification.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan. lswang@vghtpe.gov.tw
authors.forename: Hao-Wei
authors.initials: HW
authors.lastname: Wang
authors.forename: Pen-Yuan
authors.initials: PY
authors.lastname: Chu
authors.forename: Kuang-Tai
authors.initials: KT
authors.lastname: Kuo
authors.forename: Chia-Hsin
authors.initials: CH
authors.lastname: Yang
authors.forename: Shyue-Yih
authors.initials: SY
authors.lastname: Chang
authors.forename: Wen-Hu
authors.initials: WH
authors.lastname: Hsu
authors.forename: Liang-Shun
authors.initials: LS
authors.lastname: Wang
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007013:Hypopharynx / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010611:Pharyngectomy / Q000379:methods; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate