[Surgery-based multimodal therapy for cervical esophageal squamous cell carcinoma: a retrospective analysis of 117...

Objective: To evaluate the efficacy of a surgery based multimodal therapy for locally advanced resectable cervical esophageal squamous cell carcinoma, focusing on surgical indications, selection of resection and reconstruction methods, and factors influencing prognosis. Methods: A retrospective analysis was conducted on the clinical data of 117 patients with primary cervical esophageal squamous cell carcinoma treated at Department of Head and Neck Surgery, Shandong Ear-Nose-Throat Hospital from September 2014 to October 2023. The cohort consisted of 93 males and 24 females, aged from 45 to 77 years. There were 35 cases with T1-T2 stage and 82 cases with T3-T4 stage. Gastroscopy screening upon admission identified synchronous middle-inferior esophageal carcinoma in 11 cases and synchronous hypopharyngeal cancer in 4 cases. Treatment regimens were as follows: surgery with postoperative adjuvant radiotherapy in 72 cases; surgery with adjuvant concurrent chemoradiotherapy/radiotherapy plus targeted therapy in 7 cases; neoadjuvant chemotherapy (or with immunotherapy) followed by surgery and postoperative radiotherapy in 7 cases; neoadjuvant concurrent chemoradiotherapy or planned preoperative radiotherapy followed by surgery in 6 cases; and surgery alone or incomplete postoperative radiotherapy in 25 cases. Total laryngectomy was performed in 112 patients, while, 5 patients retained laryngeal function. The main reconstruction methods included free jejunal graft in 26 cases and gastric pull-up with pharyngogastric anastomosis in 91 cases. Among these, one patients underwent free jejunal graft combined with middle and lower esophageal resection, while two patients with gastric pull-up combined with free skin grafts, one patient combined with pectoralis major myocutaneous flaps, and one patient combined with free jejunal grafts reconstruction. Clinical data were analyzed using SPSS 25.0 software. Results: Follow-up was completed until Feb 2025. Eighty seven patients competed 3-year follow-up. Sixty one patients completed 5-year follow-up. The 3-year and 5-year overall survival rates were 65.0% and 50.5% calculated by the Kaplan-Meier method. Fifty patients died during follow-up, among whom 28 (56.0%) patients died from distant metastases. One patient died perioperatively. Major complications included partial gastric necrosis (n=1), vascular thrombosis of the jejunum graft requiring a second jejunal graft reconstruction (n=1) or salvageable gastric pull-up (n=1), pharyngeal fistula (n=10), severe pulmonary infection (n=3), cervical hemorrhage (n=2), pharyngeal fistula leading to pharyngogastric anastomotic stricture (n=2), and pleural effusion (n=5). Multivariate analysis revealed that T3-T4 stage,N2-N3 stage and stage Ⅲ-Ⅳ diseases were independent prognostic factors (all P<0.05). Conclusions: Surgery-based multimodal therapy for cervical esophageal squamous cell carcinoma provides favorable local control and overall survival. Free jejunal graft and gastric pull-up are the most common reliable reconstructive approaches. Multidisciplinary comprehensive treatment is crucial to ensure surgical safety and efficacy.