Laparoscopic gastric mobilization in postcricoid cancer surgery

Postcricoid cancer is an aggressive neoplasm that presents specific therapeutic problems. This study compares laparoscopic stomach mobilization following total pharyngolaryngoesophagectomy (TPLE) with open mobilization following TPLE with respect to postoperative recovery, perioperative morbidity, and mortality.

This is a retrospective study in a contemporary series of patients with resectable postcricoid cancer from a single institute (Gujarat Cancer & Research Institute, M.P. Shah Cancer Hospital, Ahmedabad, Gujarat, India). Twenty-five consecutive patients who underwent laparoscopic TPLE were compared with 40 patients who underwent open TPLE from January 2006 to December 2010.

Laparoscopic and open TPLE procedures were compared with respect to patient demographics, operative information (blood loss, duration), and complications. The mean duration of surgery was 3.5 hours in the laparoscopic group and 5.5 hours in the open group. The respective mean blood loss was 290 mL and 460 mL. The respective mean time to full oral intake was 10 days and 11 days. The respective average duration of hospitalization was 13 days and 17 days. In the laparoscopic group, 3 (12%) and 4 (16%) patients had pneumonic consolidation and wound infection, respectively, compared with 8 (20%) and 8 (20%) patients in the open group. In the laparoscopic group, there were two (8%) perioperative deaths, compared with four (10%) in the open group.

Laparoscopic TPLE is safe with less morbidity and mortality and quicker postoperative recovery compared with open surgery.