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A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction
Author(s) -
Wang HaoWei,
Chu PenYuan,
Kuo KuangTai,
Yang ChiaHsin,
Chang ShyueYih,
Hsu WenHu,
Wang LiangShun
Publication year - 2006
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20472
Subject(s) - medicine , esophagectomy , esophagus , concomitant , surgery , radiation therapy , carcinoma , esophageal neoplasm , adjuvant radiotherapy , multivariate analysis , survival rate , esophageal squamous cell carcinoma , esophageal cancer , cancer
Background Squamous cell carcinoma (SCC) in the pharyngoesophageal junction (PEJ) with concomitant involvement of both the hypopharynx and cervical esophagus occurs rarely and poses a challenge in treatment. Data regarding the long‐term result of aggressive surgical management was lacking. Methods Forty‐one consecutive patients were treated with total pharyngolaryngo‐esophagectomy (PLE) and reconstruction between 1984 and 2002. The clinicopathological parameters and prognostic data were analyzed. Results The surgery carried a postoperative mortality rate of 9.8%. The overall median survival was 18.5 months, with a 31.5% 5‐year survival rate. By multivariate analysis, patients with major tumor localization in the hypopharynx had significantly favorable prognosis (median survivals for hypopharyngeal versus esophageal localization, 37.2 versus 7.1 months, P = 0.043). The administration of adjuvant radiotherapy and tumor size less than 5 cm also contributed to a better outcome ( P = 0.001 and P = 0.037, respectively). Conclusions An aggressive surgical approach with total PLE in conjunction with adjuvant radiotherapy represents a feasible option for treatment of advanced SCC simultaneously involving the hypopharynx and cervical esophagus, given the major tumor localization in the hypopharynx. On the other hand, radical surgery for those with major esophageal localization or with tumor size larger than 5 cm yielded ominous results and warrants further justification. J. Surg. Oncol. 2006;93:468–476. © 2006 Wiley‐Liss, Inc.