Esophagectomy for esophageal cancer in patients with a history of total pharyngolaryngectomy: a Japanese nationwide retrospective cohort study

期刊论文
发表日期：

2024年8月13日

查看全文

Akihiko Okamura,
Masayuki Watanabe,
Jun Okui,
Kengo Kuriyama,
Osamu Shiraishi,
Takanori Kurogochi,
Tetsuya Abe,
Hiroshi Sato,
Hiroshi Miyata,
Yoshihiko Kawaguchi,
Yusuke Sato,
Hiroaki Nagano,
Shinsuke Takeno,
Masanobu Nakajima,
Kentaro Matsuo,
Kentaro Murakami,
Katsushi Takebayashi,
Sohei Matsumoto,
Tomoyuki Okumura,
Yoshihiro Kakeji,
Koji Kono,
Nobuhiko Oridate,
Yasushi Toh,
Hiroya Takeuchi,
Yukio Katori

摘要

Background

Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting.

Methods

We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL.

Results

Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11–70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64–3.29; P = 0.381; Ivor-Lewis as the reference).

Conclusions

In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.