Surgical management of cervical esophageal carcinoma

Abstract

OBJECTIVE: To review the experience of different surgical procedures and corresponding one-stage construction methods for cervical esophageal carcinoma. METHODS: 1. Thirty-three patients with cervical esophageal carcinoma were retrospectively reviewed, including 31 males and 2 females. According to UICC 1997 criteria and pathologic findings showing squamous cell carcinomas, there were 2 patients in T1N0, 4 in T2N0, 1 in T2N1, 6 in T3N0, 6 in T3N1, 7 in T4N0 and 7 in T4N1 categoris. 2. Removal of cervical esophagus was conducted in 13 patients. The type of cervical esophageal reconstruction included direct suturing, pectoralis major musculo-cutaneous flap or combined with the split graft, laryngotracheal flap and colon interposition. Total esophagectomy without thoracotomy was carried out in 20 patients. Reconstruction of the esophagus consisted of 17 stomach pulling-up and 3 colon interposition. Twenty-four patients received radiotherapy postoperatively(dose 50-70 Gy). RESULTS: The resectability of cervical esophageal carcinoma was 100%. The overall follow-up was from 4 months to 10 years. Two and one patient in T1, 2 survived 3 and 5 years, respectively. Three and five-year survival rates for T3, 4 were 7/16 and 3/8, respectively. Twenty-six patients had laryngeal function preserved and acquired good speech. The decannulation rate was 80% (20/25). The incidence of complication was 33.3%, including pharyngeal fistulas in 6 cases, cervical stomal fistulas in 2, cervical stomal stenosis in 2 and splitting of abdominal wall in 2. CONCLUSION: Surgical resection of cervical esophageal carcinoma and resolvation of the extraesophageal invasion is possible. The continuity of the esophagus is restored by pectoralis major muculocutaneous flap, laryngotracheal flap, stomach transposition and colon interposition. Combined with radiotherapy, the resectability and survival rate of the cervical esophageal carcinoma can be improved.