title: Technical improvement of total pharyngo-laryngo-esophagectomy for esophageal cancer and head and neck cancer.
abstract: OBJECTIVE
  Total pharyngo-laryngo-esophagectomy (PLE) is highly invasive, and the subsequent reconstruction is difficult. The purpose of this study was to clarify the techniques that can decrease the surgical stress and allow for safe reconstruction after this operation.
  
  
  METHODS
  The surgical method and clinical outcomes of total PLE were reviewed in 12 patients with either cervicothoracic esophageal cancer or double cancer of the esophagus and pharynx. Microscopic venous anastomosis was principally performed, and arterial anastomosis was added, if needed.
  
  
  RESULTS
  A narrow gastric tube was used in ten patients, including two patients who underwent free jejunal interposition, while the colon was used as the main reconstructed organ in two other patients. Staged operations were performed in three high-risk patients. All six patients treated after 2010 were able to undergo thoracoscopic and/or laparoscopic surgery. No critical postoperative complications developed, although minor anastomotic leakage developed in two patients who were successfully treated conservatively.
  
  
  CONCLUSIONS
  When performing PLE, it is important to decrease the surgical stress and ensure a reliable reconstruction by adopting techniques that are appropriate for each case, such as thoracoscopic and laparoscopic surgery, staged operations, microvascular anastomosis, and muscular flaps.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, masarum@surg2.med.kyushu-u.ac.jp.
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Shuhei
authors.initials: S
authors.lastname: Ito
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ikeda
authors.forename: Nami
authors.initials: N
authors.lastname: Yamashita
authors.forename: Koji
authors.initials: K
authors.lastname: Ando
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Hiyoshi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ida
authors.forename: Eriko
authors.initials: E
authors.lastname: Tokunaga
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Sei
authors.initials: S
authors.lastname: Yoshida
authors.forename: Torahiko
authors.initials: T
authors.lastname: Nakashima
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010614:Pharynx / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D019651:Plastic Surgery Procedures