Surgery for synchronous double cancer in the hypopharynx and thoracic esophagus

Problems involved in the surgical treatment of synchronous double cancer comprising hypopharyngeal and thoracic esophageal cancers were considered from the aspects of the radicality of treatment and the quality of life following surgery. Advanced esophageal cancers were treated by resection with lymph node dissection via right thoracotomy, and early cancers by transhiatal esophagectomy or endoscopic mucosal resection. When the entire thoracic esophagus was extirpated, the gastric tube was usually used for reconstruction. When the hypopharyngeal cancer extended to the higher oropharynx or when resection of the tongue was combined, complex reconstruction was undertaken using free grafting with a combination of the gastric tube and the jejunum or a flap such as a forearm flap or rectus abdominis musculocutaneous flap. Since endoscopic esophageal mucosal resection allows the preservation of the thoracic esophagus, the hypopharyngeal cervical esophagus was reconstructed using a free jejunal graft. Although surgical treatment provided no sufficient improvement in prognosis, postoperative quality of life was satisfactory.