A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction.
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.
Wang
Hao-Wei
HW
Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan. lswang@vghtpe.gov.tw
Chu
Pen-Yuan
PY
Kuo
Kuang-Tai
KT
Yang
Chia-Hsin
CH
Chang
Shyue-Yih
SY
Hsu
Wen-Hu
WH
Wang
Liang-Shun
LS
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