title: Larynx-preserving limited resection and free jejunal graft for carcinoma of the cervical esophagus.
abstract: BACKGROUND
  There is no generally accepted treatment strategy for cervical cancer. The aim of this study was to evaluate the safety and efficacy of larynx-preserving limited resection with free jejunal graft for cervical esophageal cancer.
  
  
  METHODS
  We retrospectively reviewed data of 58 patients with cervical esophageal cancer who underwent limited resection and free jejunal graft with or without laryngeal preservation. Among them, 45 patients received neoadjuvant treatment.
  
  
  RESULTS
  Larynx-preserving surgery was conducted in 33 of the 58 patients (56.9%). A higher proportion of patients who underwent laryngopharyngectomy with cervical esophagectomy (larynx-nonpreserving group) had cT4 tumors than those who underwent larynx-preserving cervical esophagectomy (larynx-preserving group) (72 vs. 12%). The overall incidence of postoperative complications was similar in the two groups (56 vs. 52%). The 5-year survival rate was 44.9% for the entire group. Laryngeal preservation did not reduce overall survival compared with the larynx-nonpreserving operation (5-year survival rate: 57.8 vs. 25.8%). Multivariate analysis identified the number of metastatic lymph nodes as the only independent prognostic factor.
  
  
  CONCLUSIONS
  The present study demonstrated that larynx-preserving limited resection with free jejunal graft is feasible. Also, this approach did not worsen the prognosis compared with the larynx-nonpreserving operation. Limited resection with free jejunal graft and laryngeal preservation is a promising treatment strategy for cervical esophageal cancer.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. hmiyata@gesurg.med.osaka-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007564:Japan; D007583:Jejunum / Q000601:surgery / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D007830:Larynx / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome