title: Influence of resection extent on morbidity in surgery for squamous cell cancer at the pharyngoesophageal junction.
abstract: OBJECTIVE
  Squamous cell cancer (SCC) of the pharyngoesophageal junction area has a poor prognosis mainly due to late symptom manifestation and diagnosis. Treatment of choice is still pharyngolaryngoesophagectomy, substantially affecting quality of life. Limited surgical procedures have been adopted as well. The aim of this retrospective study was to evaluate whether the extent of resection influences postoperative safety and mortality.
  
  
  METHODS
  From 1984 to 2006, 66 patients were operated at a single tertiary referral center. Nineteen patients (28.8 %) had SCC of the hypopharynx and 47 patients (71.2 %) had SCC of the cervical and cervicothoracic esophagus. Thirty-five patients (53.0 %) underwent cervical esophageal resection (CE) and 31 underwent total esophagectomy (TE). In 39 patients (59.1 %), the larynx was preserved. Thirteen patients (19.7 %) underwent multimodal treatment.
  
  
  RESULTS
  Overall postoperative morbidity was 69.7 % and reoperation rate reached 28.8 %. TE (P = 0.03) and larynx preservation (P = 0.02) were followed by a higher rate of non-lung infections compared with CE and pharyngolaryngectomy, respectively. Pulmonary complications have been observed more frequently after larynx preservation (P = 0.02). Hospital mortality was 9.1 %. Four patients died after TE (12.9 %) and two patients died after CE (5.7 %). In all of them, the larynx had been preserved (15.4 %). Overall, 53 patients (80.3 %) died until follow-up. One-year and 5-year survival in patients with the major tumor burden at the cervicothoracic site was 35.7 and 0 %.
  
  
  CONCLUSIONS
  CE can be recommended as long as R0 resection is warranted. The advantage of larynx preservation is gained by higher morbidity and mortality rates and may not be recommended as standard procedure. Surgery may not be appropriate for advanced SCC in the cervicothoracic region.
authors.affiliation: Department of General Surgery, University Clinic of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria. peter.panhofer@meduniwien.ac.at
authors.forename: Peter
authors.initials: P
authors.lastname: Panhofer
authors.forename: Christopher
authors.initials: C
authors.lastname: Springer
authors.forename: Barbara
authors.initials: B
authors.lastname: Izay
authors.forename: Matthäus
authors.initials: M
authors.lastname: Grasl
authors.forename: Martin
authors.initials: M
authors.lastname: Burian
authors.forename: Sebastian F
authors.initials: SF
authors.lastname: Schoppmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Rath
authors.forename: Raimund
authors.initials: R
authors.lastname: Jakesz
authors.forename: Johannes
authors.initials: J
authors.lastname: Zacherl
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010611:Pharyngectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome