A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction

Hao Wei Wang, Pen Yuan Chu, Kuang Tai Kuo, Chia Hsin Yang, Shyue Yih Chang, Wen Hu Hsu, Liang Shun Wang

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)468-476
Number of pages9
JournalJournal of Surgical Oncology
Volume93
Issue number6
DOIs
Publication statusPublished - May 1 2006
Externally publishedYes

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Hypopharynx
Squamous Cell Carcinoma
Adjuvant Radiotherapy
Esophagectomy
Esophagus
Neoplasms
Survival
Multivariate Analysis
Survival Rate
Mortality
Therapeutics

Keywords

  • Esophageal cancer
  • Hypopharyngeal cancer
  • Pharyngolaryngo-esophagectomy
  • Prognosis
  • Squamous cell carcinoma

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction. / Wang, Hao Wei; Chu, Pen Yuan; Kuo, Kuang Tai; Yang, Chia Hsin; Chang, Shyue Yih; Hsu, Wen Hu; Wang, Liang Shun.

In: Journal of Surgical Oncology, Vol. 93, No. 6, 01.05.2006, p. 468-476.

Research output: Contribution to journalArticle

Wang, Hao Wei ; Chu, Pen Yuan ; Kuo, Kuang Tai ; Yang, Chia Hsin ; Chang, Shyue Yih ; Hsu, Wen Hu ; Wang, Liang Shun. / A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction. In: Journal of Surgical Oncology. 2006 ; Vol. 93, No. 6. pp. 468-476.
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AB - 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.

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