CANCER OF THE HYPOPHARYNX AND CERVICAL ESOPHAGUS

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 patients with a carcinoma of the cervical esophageal region arising after laryngectomy for laryngeal cancer. The mean age was 57.5 years (range 41-73). 167 patients underwent surgical exploration (operability rate 59.5 %) and in 152 cases the tumor was resected (resectability rate 91.1 %). The resection was complete in 129 patients (84.5 %) and palliative in 23 (14.5 %). In 33 cases a segmental laryngo-pharyngo-cervical esophagectomy with free intestinal loop transplantation was performed with an operative mortality of 6.1 %. 101 patients underwent total laryngo-pharyngo esophagectomy and the gastrointestinal tract was reconstructed by means of pharyngo-gastrostomy and pharyngo-colostomy in 85 and 16 cases, with an operative mortality of 12.9 % and 18.3 %, respectively. Total esophagectomy without laryngectomy was performed in 18 patients with a carcinoma of the distal cervical esophagus refusing laryngectomy with a hospital mortality of 5.5 %. The overall 5-year acturial survival, excluding the operative mortality, was 15.8 %. After complete resection, better results were recorded with patients operated for carcinoma of the hypopharynx than with patients with carcinoma of the cervical esophagus : the 2-year and 5-year acturial survival was 59 % vs 26 % and 43 % vs 17 %, respectively. No patient undergoing palliative resection was alive at the 3-year interval. Similarly, none of the patients with carcinoma of the distal esophagus in whom the resection did not include laryngectomy or with carcinoma of the cervical esophagus who previously underwent laryngectomy for laryngeal cancer were alive at the 3-year interval independently of the intent of surgery. In conclusion : surgery is the treatment of choice for hypopharyngeal and cervical esophageal carcinoma ; it carries acceptable morbidity and mortality rates, providing a better survival than radiation and/or chemotherapy. Improvement in the long term results requires trials including adjuvant and neo-adjuvant treatments combined with surgery. From the oncological point of view, total laryngo-pharyngo esophagectomy is a more effective procedure than segmental laryngo-pharyngo-cervical esophagectomy.