“Larynx-preserving surgery” for cervical esophageal carcinoma can preserve the vocal function and improve the clinical outcome

At our institution, larynx-preserving surgery has been aggressively performed for cervical esophageal carcinoma, even when the oral side of the tumor margin extends beyond the esophageal orifice. Our aim was to clarify the clinical outcomes of surgery, with a focus on larynx-preserving surgery.

Eleven patients who were diagnosed with resectable cervical esophageal carcinoma and received larynx-preserving surgery as the initial treatment were enrolled. For larynx-preserving surgery, the following two surgical techniques were introduced: the “larynx rotation method,” where the larynx and hypopharynx are manually rotated counterclockwise more than 90° by holding down the thyroid cartilage, and the “tracheal traction method,” where the trachea is moved forward with the larynx and hypopharynx. By selecting these methods, the transection of the cervical esophagus on the oral side of the tumor and anastomosis with a substituted organ can thus be achieved, even around the narrow area surrounded by the larynx, trachea and vertebral body. Nine patients who received definitive chemoradiotherapy as the initial treatment were also enrolled to compare the long-term clinical outcomes.

Larynx-preserving surgery was successfully performed and the larynx could thus be preserved in all the cases. Although all patients developed recurrent nerve paralysis, including two patients who showed bilateral recurrent nerve paralysis, such paralysis was temporary. Although postoperative pneumonia, surgical site infection, and anastomotic stenosis were experienced, these problems were not severe and the postoperative morbidities were tolerable. The recurrence rate was 36.4 %, and the 5-year progression-free survival rate and overall survival rate were 62.3 and 90.9 %, respectively. There was no significant difference in the long-term clinical outcomes between the patients who underwent larynx-preserving surgery and chemoradiotherapy

Larynx-preserving surgery is considered to be acceptable because both organ preservation and functional preservation can be achieved with tolerable long-term clinical outcomes.