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01.05.2014 | Gastrointestinal Oncology | Ausgabe 5/2014

Annals of Surgical Oncology 5/2014

Technical Improvement of Total Pharyngo-Laryngo-Esophagectomy for Esophageal Cancer and Head and Neck Cancer

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 5/2014
Autoren:
MD, PhD, FACS Masaru Morita, MD, PhD, FACS Hiroshi Saeki, MD, PhD Shuhei Ito, MD Keisuke Ikeda, MD, PhD Nami Yamashita, MD, PhD Koji Ando, MD, PhD Yukiharu Hiyoshi, MD, PhD Satoshi Ida, MD, PhD Eriko Tokunaga, MD, PhD Hideaki Uchiyama, MD, PhD, FACS Eiji Oki, MD, PhD Tetsuo Ikeda, MD Sei Yoshida, MD, PhD Torahiko Nakashima, MD, PhD, FACS Yoshihiko Maehara

Abstract

Purpose

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.

Conclusion

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.

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