Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker's) diverticulum.

The incidence of cancer in a pharyngoesophageal (Zenker's) diverticulum was 0.4% among 1,249 patients treated for such diverticula at the Mayo Clinic in a 53-year period. Twenty-four patients with squamous cell carcinoma arising in a pharyngoesophageal diverticulum have been reported by others. However, most of the patients died of the malignancy within 2 years of treatment, and there were no long-term survivors. We describe 2 long-term survivors who were without evidence of tumor or diverticulum recurrence 4 1/4 and 8 years after one-stage pharyngoesophageal diverticulectomy. Review of the literature revealed that most patients with cancer in pharyngoesophageal diverticulum should be managed in a manner similar to that for patients with ordinary cervical esophageal malignancy. However, our data suggest that when the tumor is well localized without full-thickness penetration, nodal metastasis, or extension to the line of resection (as in the 2 patients discussed), diverticulectomy alone can provide satisfactory control of cancer with minimal therapeutic risk.