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Comparison of salvage and planned pharyngolaryngectomy with jejunal transfer for hypopharyngeal carcinoma after chemoradiotherapy
Author(s) -
Kadota Hideki,
Fukushima Junichi,
Nakashima Torahiko,
Kumamoto Yoshihiko,
Yoshida Sei,
Yasumatsu Ryuji,
Shiratsuchi Hideki,
Morita Masaru,
Komume Shizuo
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20887
Subject(s) - medicine , perioperative , surgery , chemoradiotherapy , salvage therapy , salvage surgery , chemotherapy , radiation therapy
Objectives/Hypothesis: Salvage surgery after definitive chemoradiotherapy is often associated with a higher rate of perioperative complications and poor prognosis. The objective of this study is to examine the safety and efficacy of free jejunal transfer after salvage pharyngolaryngectomy for patients with locally recurrent hypopharyngeal carcinoma after definitive chemoradiotherapy. Study Design: A retrospective analysis of patients with advanced hypopharyngeal carcinoma who underwent pharyngolaryngectomy and reconstruction using free jejunum. Methods: Forty patients who underwent pharyngolaryngectomy with jejunal transfer were included in this study. Fourteen patients underwent surgery after definitive chemoradiotherapy (the salvage‐surgery group), whereas 26 patients underwent surgery after planned preoperative chemoradiotherapy (the planned‐surgery group). The perioperative conditions, mortality, morbidity, functional outcomes, and oncologic outcomes in each group were compared. Results: The patients in the salvage‐surgery group lost an average of 9 kg in weight before surgery, which thus indicated a malnourished condition. However, the incidence of all perioperative complications did not differ significantly between the groups. All patients in both groups achieved oral intake without tube feeding, and the intervals to start oral intake were 12.8 days in the salvage‐surgery group and 15.6 days in the planned‐surgery group, which was not significantly different. The 5‐year disease‐free survival was 57.1% in the salvage‐surgery group and 50.4% in the planned‐surgery group, which was not significantly different. Conclusions: Salvage pharyngolaryngectomy and jejunal transfer can be performed safely and reliably for patients with locally recurrent hypopharyngeal carcinoma, and it is an excellent option after a failure of definitive chemoradiotherapy.