Gastric transposition for head and neck cancer: a critical update

We reviewed our experience with 120 patients who had gastrointestinal (GI) continuity restored by gastric transposition after cervical esophagectomy or circumferential pharyngectomy. This included 62 patients with pharyngeal tumors, 43 with esophageal lesions, 7 with parastomal recurrences, and 8 with other primaries (including 4 with thyroid cancer). Operative mortality (11%) for this two-team procedure was significantly higher in patients 60 years of age or older, and there was a trend toward higher mortality in those who had resection of esophageal rather than pharyngeal primaries (14% versus 5%). A total of 105 intraoperative or perioperative complications occurred in 66 patients (55%), 81 of which were directly related to the surgery and 24 of which involved various organ systems. Aside from 15 anastomotic leaks (13%) and 3 instances of partial stomach necrosis (3%), most of the local complications were relatively minor. Our experience indicates that the transposed stomach is highly reliable for restoration of GI continuity, but complications are frequent and the mortality is high. Careful patient selection is essential to minimize morbidity.