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Survival and function following pharyngo-laryngo-oesophagectomy in Wales: a twelve-year case series

Published online by Cambridge University Press:  29 January 2021

D R Edwards*
Affiliation:
Department of ENT/Head and Neck Surgery, Royal Gwent Hospital, Wales, UK
L Pope
Affiliation:
Department of ENT/Head and Neck Surgery, Morriston Hospital, Wales, UK
S Berry
Affiliation:
Department of ENT/Head and Neck Surgery, University Hospital of Wales, Cardiff, Wales, UK
*
Author for correspondence: Mr Daniel Rhys Edwards, Department of ENT/Head and Neck Surgery, Royal Gwent Hospital, Cardiff Road, NewportNP20 2UB, Wales, UK E-mail: [email protected]

Abstract

Objective

Treatment of locally advanced hypopharyngeal cancer can cause significant morbidity and late toxicity. Pharyngo-laryngo-oesophagectomy can achieve adequate surgical margins, but data on survival and functional outcome are limited, especially in Wales. This study aimed to describe mortality, morbidity and functional outcome following pharyngo-laryngo-oesophagectomy in a Welsh population.

Method

This study was a retrospective case note review of pharyngo-laryngo-oesophagectomy cases in Wales over 12 years.

Results

Fifteen patients underwent pharyngo-laryngo-oesophagectomy; all but one underwent gastric pull-up. Median survival and disease-free survival were 17 months (range, 2–53 months) and 14 months. Censored 3-month, 1-year and 3-year survival was 93, 71 and 50 per cent, respectively. Common Terminology Criteria for Adverse Events grading of long-term dysphagia was 1 in 58 per cent, 2 in 33 per cent and 3 in 8 per cent, and 87.5 per cent achieved a ‘moderate’ or ‘good’ voice rehabilitation.

Conclusion

These results demonstrate favourable survival and reasonable functional outcome following pharyngo-laryngo-oesophagectomy, suggesting pharyngo-laryngo-oesophagectomy should be considered in all appropriate surgical candidates.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr D Edwards takes responsibility for the integrity of the content of the paper

Presented at ENT Wales Annual Meeting, 4th October 2019, Saundersfoot, UK.

References

Ho, CM, Ng, WF, Lam, KH, Wei, WJ, Yuen, AP. Submucosal tumor extension in hypopharyngeal cancer. Arch Otolayngol Head Neck Surg 1997;123:959–65CrossRefGoogle ScholarPubMed
Pracy, P, Loughran, S, Good, J, Parmar, S, Goranova, R. Hypopharyngeal cancer: United Kingdom National Multidisciplinary guidelines. J Larngol Otol 2016;130(suppl S2):104–10CrossRefGoogle ScholarPubMed
Butskiy, O, Rahmanian, R, White, RA, Durham, S, Anderson, DW, Prisman, E. Revisiting the gastric pull–up for pharyngoesophageal reconstruction: a systematic review and meta-analysis of mortality and morbidity. J Surg Onc 2016;114:907–14CrossRefGoogle ScholarPubMed
Meulemans, J, Couvreur, F, Beckers, E, Nafteux, P, Van Veer, H, Poorten V, Vander et al. Oncologic and functional outcomes after primary and salvage laryngopharyngoesophagectomy with gastric pull-up reconstruction for locally advanced hypopharyngeal squamous cell carcinoma. Front Oncol 2019;9:735CrossRefGoogle ScholarPubMed
Marion, Y, Lebreton, G, Brevart, C, Sarcher, T, Alves, A, Babin, E. Gastric pull-up reconstruction after treatment for advanced hypopharyngeal and cervical esophageal cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2016;133:397400CrossRefGoogle ScholarPubMed
Ullah, R, Bailie, N, Kinsella, J, Anikin, V, Primrose, WJ, Brooker, DS. Pharyngo-laryngo-oesophagectromy and gastric pull-up for post-cricoid and cervical oesophageal squamous cell carcinoma. J Laryngol Otol 2002;116:826–30CrossRefGoogle ScholarPubMed
Liu, J, Zhang, Y, Li, Z, Liu, S, Li, H, Xu, Z. Benefit of salvage total pharyngolaryngoesophagectomy for recurrent locally advanced head and neck cancer after radiotherapy. Radiat Oncol 2017;12:164CrossRefGoogle ScholarPubMed
Rinkel, RN, Verdonck-de Leeuw, IM, van den Brakel, N, de Bree, R, Eerenstein, SE, Aaronson, N et al. Patient-reported symptom questionnaires in laryngeal cancer: voice, speech and swallowing. Oral Oncol 2014;50:759–64CrossRefGoogle ScholarPubMed
Machtay, M, Moughan, J, Trotti, A, Garden, AS, Weber, RS, Cooper, JS et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Onc 2008;26:3582–9CrossRefGoogle ScholarPubMed
Machtay, M, Moughan, J, Farach, A, Martin-O'Meara, E, Galvin, J, Garden, AS et al. Hypopharyngeal dose is associated with severe late toxicity in locally advanced head-and-neck cancer: an RTOG analysis. Int J Radiat Oncol Biol Phys 2012;84:983–9CrossRefGoogle ScholarPubMed
Li, M, Xie, M, Zhou, L, Wang, S. The impact of surgical margin status on the outcomes of locally advanced hypopharyngeal squamous cell carcinoma treated by primary surgery. Acta Otolaryngol 2018;138:1136–45CrossRefGoogle ScholarPubMed
Iwae, S, Fujii, M, Hayashi, R, Hasegawa, Y, Fujii, T, Okami, K et al. Matched-pair analysis of patients with advanved hypopharyngeal cancer: surgery versus concomitant chemoradiotherapy. Int J Clin Oncol 2017;22:1001–8CrossRefGoogle Scholar
Habib, A. Management of advanced hypopharyngeal carcinoma: systematic review of survival following surgical and non-surgical treatments. J Laryngol Otol 2018;132:385400CrossRefGoogle ScholarPubMed
Siddiq, S, Paleri, V. Outcomes of tumour control from primary treatment of hypopharyngeal cancer. Adv Otorhinolaryngol 2019;83:90108Google ScholarPubMed