Limited resection and free jejunal graft interposition for squamous cell carcinoma of the cervical oesophagus.
BACKGROUND
Therapeutic strategies for cervical oesophageal squamous cell carcinoma (SCC) are controversial. Treatment options range from definitive radiotherapy to multimodal treatment. Outcome after limited resection and reconstruction with a free jejunal graft interposition was evaluated retrospectively.


METHODS
Patients with clinical T1-4 Nx M0 tumours treated between 1986 and 2006 were included.


RESULTS
Of 109 patients, 94 underwent preoperative chemoradiotherapy and 15 had a primary resection. Complete or partial preservation of the larynx was achieved in 93 patients (85.3 per cent). Minor and major complications occurred in 74.3 per cent, with 44.0 per cent of all patients having more than one complication. Reoperation was necessary in 29.4 per cent. The 30-day mortality rate was 1.8 per cent, and the in-hospital mortality rate 2.8 per cent. The complete R0 resection rate was 72.5 per cent. Median overall survival was 34.3 months; 1-, 3- and 5-year survival rates were 83.8, 47.0 and 47.0 per cent respectively. Survival was not influenced by complications (P = 0.401) or reoperation (P = 0.428).


CONCLUSIONS
Despite high complication and reoperation rates, the mortality rate was low, even after preoperative chemoradiation. This complex surgical strategy is a treatment option for cervical SCC in oncological centres with an infrastructure providing multidisciplinary management.
Ott
K
K
Department of Surgery, University of Heidelberg, Heidelberg, Germany. katja.ott@med.uni-heidelberg.de
Lordick
F
F
Molls
M
M
Bartels
H
H
Biemer
E
E
Siewert
J R
JR
D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D007825:Laryngectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D013524:Surgical Flaps; D016896:Treatment Outcome