Transhiatal esophagectomy with gastric transposition for pharyngolaryngeal malignant disease

Between 1981 and 1988, 41 patients underwent pharyngolaryngoesophagectomy with transhiatal gastric transposition and primary pharyngogastrostomy for hypopharyngeal, laryngeal, and cervical esophageal carcinoma. All patients had squamous cell carcinoma. Twenty-one patients had been treated initially by high-dose radiotherapy, but the tumor had either persisted or recurred. Four patients had previously received high-dose local radiotherapy to the neck for unrelated diseases, and in 16 patients no preoperative radiotherapy was given. There was one operative death. Anastomotic leaks developed in nine previously irradiated patients and three required flap reconstructions. Thirty patients had satisfactory swallowing postoperatively and three swallowed poorly. Delayed gastric emptying was a serious problem in two patients, necessitating pyloric bag dilatation in one and pyloroplasty in another. The average postoperative stay was 31 days. Thirty-seven percent survived longer than 12 months and 15% longer than 24 months. The probability of survival after 2 years is 35%. All deaths from recurrent disease occurred within 412 days postoperatively. At present, pharyngolaryngoesophagectomy with gastric transposition and primary pharyngogastric anastomosis offers the best chance for cure or palliation with acceptable morbidity and function for selected patients with advanced hypopharyngeal and laryngeal tumors.