Pharyngo-laryngo-oesophagectomy and gastric pull-up (PLOGP) is a complex and relatively uncommon procedure. The aim of this study is to analyse the results of PLOGP in patients with post-cricoid and cervical oesophageal squamous cell carcinomas.

This study was a retrospective review of 26 patients (11 males + 15 females, mean age 63.5 years) who underwent PLOGP from 1988 to 1997. Eighteen (69 per cent) patients were staged as T3 and eight (31 per cent) T4. Eighteen (69 per cent) patients had N0, seven (27 per cent) N1 and one (four per cent) N2 disease. Multiple primary tumours were recorded in three (11.5 per cent) patients. Four (15 per cent) patients had pre-operative radiotherapy with poor response and two (eight per cent) required emergency tracheotomy prior to surgery. Feeding jejunostomy was performed on 19 (73 per cent) and neck lymph node dissection in eight (31 per cent) patients.

The mean duration of surgery was five hours (range 3.5 to 7.5) with a mean blood loss of 840 ml (range 160 to 1800), a mean stay in ICU of 4.2 days and hospital stay ranged from nine to 84 days (mean 34). Three (11.5 per cent) patients died (pneumonia – one, congestive heart failure – one pulmonary embolus – one) in the early post-operative period. Eight (31 per cent) patients remain alive from 30 to 136 months (mean 58 months). Two (eight per cent) patients died with no evidence of disease. Thirteen (50 per cent) patients died of their disease between two to 51 months (mean 17.3 months) post-operatively. Kaplan-Meier survival estimates for one year was 65 per cent, for three years 35 per cent and for five years 26 per cent (see Figure 1). Median survival in the whole series was 18 months.

Post-operative speech was with an electrolarynx in 16 (62 per cent). One patient (four per cent) used gastric speech and one patient (four per cent) used a Blom-Singer valve effectively. Five (19 per cent) patients had no speech post-operatively. All patients maintained oral feeding. Gastric transposition constitutes a safe and reliable method of restoring the continuity of the upper digestive tract following pharyngo-laryngo-oesophagectomy.

Carcinomas of the pharyngo-oesophageal junction continue to be a challenge to head and neck surgeons. We report a series of 30 patients who underwent gastric transposition for advanced pharyngo-oesophageal tumours, with personal insights about the surgical technique and the need for neck and mediastinal node dissection. The median hospital stay was 21.6 days, with resumption of oral feedings around the 16th day in 91.7 per cent of the surgical survivors. Ten patients had multiple primary tumours (33.3 per cent), with 20 per cent of synchronous carcinomas. Serious local and systemic complications occurred in 17 patients (56.7 per cent), the most important being tracheal complications, cervical and systemic infections, fistulas, rupture of major vessels and pulmonary embolus. Post-operative deaths occurred in 20 per cent of the patients. The locoregional control of disease was significant (only 14.2 per cent of deaths from regional recurrence) but 64.2 per cent of the patients died from distant metastasis. Survival without disease was 13.3 per cent at five years. Gastric transposition was judged to be the procedure of choice for palliation or occasional cure in patients with pharyngo-oesophageal tumours.

In general, malignancies presenting as abscesses are uncommon. We report on a patient that presented with a neck abscess originating in a cluster of metastatic lymph nodes from a primary squamous cell carcinoma arising in the thoracic oesophagus.