Long-Term Survival of Patients After Total Pharyngolaryngoesophagectomy With Gastric Pull-Up Reconstruction for Hypopharyngeal or Laryngeal Cancer Invading Cervical Esophagus

• Published in: Annals of otology, rhinology & laryngology Vol. 132; no. 5; pp. 511 - 518
• Main Authors: Bich, Tran Anh, Vuong, Nguyen Lam, Cam Tu, Nguyen Cong Huyen Ton Nu, Truong, Tran Minh, Trung, Lam Viet
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-05-2023
• Subjects: Esophagus - surgery; Female; Hospital Mortality; Humans; Hypopharyngeal Neoplasms - pathology; Hypopharyngeal Neoplasms - surgery; Hypopharynx - surgery; Laryngeal Neoplasms - surgery; Male; Middle Aged; Retrospective Studies; pharyngeal cancer; laryngopharyngoesophagectomy; laryngeal cancer; survival
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/00034894221098802

Objectives:
Hypopharyngeal and laryngeal cancers are aggressive and usually diagnosed at advanced stage with esophagus invasion. Total pharyngolaryngoesophagectomy with gastric pull-up reconstruction has been a common surgery for these cancers but long-term outcomes are still questionable. This study aimed to investigate short-term and long-term outcomes of patients who underwent this surgery.
Methods:
Patients with hypopharyngeal or laryngeal cancer invading cervical esophagus who underwent total pharyngolaryngoesphagectomy with gastric pull-up between 2012 and 2016 was included and followed up until 2021. Short-term outcomes were complications and long-term outcomes were overall survival (OS) and disease-free survival (DFS).
Results:
Fifty patients were included with a mean age of 60.3 years and 94% were male. Pyriform fossa was the most common primary site of tumor (50%), followed by posterior hypopharyngeal wall (18%) and postcricoid region (18%). Mean operating time, postoperative oral intake and hospital stay was 363.1 ± 43.6 minutes, 8.8 ± 3.6 days and 14.2 ± 3.0 days respectively. Complications occurred in 15 patients (30%) without any in-hospital death. During the follow-up period, 17 patients had recurrence and 35 patients died. Median (95% confidence interval [CI]) OS and DFS time were 30 (21-37) and 30 (19-36) months. Five-year OS and DFS probability (95% CI) were 22.6% (12.8-39.7) and 22.7% (12.9-39.8).
Conclusions:
Total pharyngolaryngoesophagectomy with gastric pull-up is feasible and safe. However, even with curative surgery and multimodal treatment, advanced pharyngeal or laryngeal cancer with cervical esophagus invasion still has poor survival outcome.