Gastric pull-up reconstruction after treatment for advanced hypopharyngeal and cervical esophageal cancer.
OBJECTIVE
In advanced hypopharyngeal and cervical esophageal carcinoma, the choice of reconstruction technique after total circumferential pharyngolaryngectomy (TCPL) remains controversial. We studied results of digestive tract reconstruction using gastric pull-up, concomitant or secondary to TCPL or after failure of reconstruction.


METHODS
Twenty-four patients treated by gastric pull-up after TCPL for advanced hypopharyngeal or cervical esophageal carcinoma between December 1998 and January 2011 were retrospectively reviewed.


RESULTS
Two-year survival was 37.5% (n=9). Thirty-day mortality was 4.1% (n=1), but 3 more patients died before discharge. Perioperative morbidity was 54.1% (n=13), including 9 fistulas (37.5%). Seventeen patients (71%) recovered oral feeding.


CONCLUSIONS
Gastric pull-up is an interesting reconstruction technique after TCPL with invasion of the esophageal mouth, allowing comfortable oral feeding, but with non-negligible morbidity and mortality. Long-term survival is not high, partly due to the unfavorable prognosis of advanced hypopharyngeal and cervical esophageal tumor. The present high rate of fistula raises doubts for this surgery as second-line reconstruction after primary failure.
Service de chirurgie digestive, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Faculté de médecine, université de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France. Electronic address: marion-y@chu-caen.fr.
Y
Y
Marion
Service de chirurgie digestive, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Faculté de médecine, université de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
G
G
Lebreton
Service de chirurgie digestive, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Faculté de médecine, université de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
C
C
Brévart
Service de chirurgie digestive, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Faculté de médecine, université de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
T
T
Sarcher
Service de chirurgie digestive, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Faculté de médecine, université de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
A
A
Alves
Faculté de médecine, université de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
E
E
Babin
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005402:Fistula / Q000209:etiology; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007431:Intraoperative Complications; D007582:Jejunostomy; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*
Hypopharyngeal neoplasm; Laryngeal Neoplasm; Laryngectomy; Pharyngectomy; Stomach/surgery; Stomach/transplantation; Surgical reconstruction