Present status of pharyngolaryngo-esophagectomy

Abstract

Pharyngolaryngo-esophagectomy and pharyngogastric anastomosis (PLO & PGA) is one of the surgical options in the management of tumors located at the hypopharyngeal and cervical esophageal region. Over the years, indications of this operation have changed and so are the results. The experience of performing this operation in our Institute over the last thirty years was reviewed to entablish the present status of this operation. A total of 317 patients underwent the operation PLO & PGA from 1966 to 1995 in the department of surgery, University of Hong Kong Medical Center, at Queen Mary Hospital, Hong Kong. The clinical results of 69 patients operated on between 1986 and 1995 were analyzed in detail and compared with that of patients in the two periods reported previously from the same Institute, to show the changing trend. During the seventies and eighties, for those who underwent the operation, in 53% of them, the primary tumors were advanced laryngeal carcinomas extending to the hypopharynx, while for the other 47% patients, their primary tumor were hypopharyngeal and cervical esophageal malignancies. In recent years, all patients belonged to the latter group. Over the years, the hospital mortality has decreased from 31% to 9% and the incidence of bleeding, anastomosic leakage and other major morbidities have also reduced from 20% to 10%. These are likely to be related to patient selection and some technical modifications. The latter include the introduction of transthoracic endoscopic mobilization of the esophagus and the various measures to produce a tensionless anastomosis at the pharyngogastric suture line. The overall minor morbidity has, however, remained at around 49% and the 5-year actuarial survival rate following this operation has improved from 18% in the seventies to 24.5% recently.