Surgical management of cervical esophageal carcinoma with larynx preservation and reconstruction.

[esophageal carcinoma]

There is no generally accepted treatment strategy for cervical esophageal carcinoma . The purpose of this study was to evaluate the operative outcomes of reconstruction after resection of cervical esophageal and hypopharynx-esophagus junction carcinoma with larynx preservation .We retrospectively reviewed the data of 79 patients with carcinoma of the hypopharynx-esophagus junction and cervical esophagus . Transhiatal total esophagectomy without thoracotomy was carried out in 67 patients who underwent gastric pull-up (GP ) or colon interposition (CI ) techniques . Transcervical limited pharyngo-cervical esophagectomy was performed in the patients with the pectoralis major flap alone or combined with the split graft (PMF /CWSG ) for reconstruction . Seventy -two patients received postoperative adjuvant therapy .The 3 -year and 5 -year overall survival rates were 66 .4 % and 45 .5 %, respectively . The average time to resumption of oral feeding was 25 .2 days . All patients had preserved laryngeal function . The overall incidence of complications was 29 .1 % (23 /79 ), which included cervical fistula , abdominal wound dehiscence , liquefaction necrosis of abdominal fat , and pleural effusion .Surgical resection of cervical esophageal carcinoma and laryngeal preservation is possible . Complete esophagectomy should be performed when the resection extends below the thoracic inlet . The reconstruction methods we performed were safe and effective for the immediate restoration of alimentary continuity after resection of cervical esophageal and pharyngo-cervical esophageal carcinoma ; and the patients with PMF /CWSG reconstruction had a better survival than those with GP or CI reconstruction . Combined with radiotherapy , the resectability rate and survival rate of cervical esophageal carcinoma can be improved .