Cervical esophageal reconstruction for heavily irradiated patients. Feasibility of a one-stage procedure.

SURGERY for the heavily irradiated patient with advanced hypopharyngeal carcinoma is challenging. Preoperative irradiation increases the incidence and severity of postoperative wound complications. 1-3 It is essential that operative techniques be devised to overcome these added hazards. The purposes of this paper are (1) to review our experience with a two-stage technique of cervical esophageal reconstruction in heavily irradiated individuals with advanced hypopharyngeal carcinoma and (2) to propose a one-stage transplantation of a revascularized autogenous jejunal segment to replace the resected hypopharynx and cervical esophagus. Cancer of the hypopharynx is commonly a silent lesion until it is far advanced with wide local extension and metastasis to regional lymph nodes. Recent statistics of extensive hypopharyngeal lesions treated by radiotherapy alone have resulted in five-year survival rates of 4% to 20%. 4-6 Surgical cure rates for advanced hypopharyngeal tumors range between 0% and 33%. 6,7 Others have searched for an improvement in cure

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