Therapeutic options for cancer of the hypopharynx and cervical oesophagus.

Between 1980 and 1990, 291 patients with a cancer in the cervical area of the oesophagus were admitted to our Department: in 187 the cancer was located mainly in the cervical region, 76 in the hypopharynx and 28 had a tumour that had spread to the cervical oesophageal region following laryngectomy. Most tumours of the hypopharynx involved the cervical oesophagus when it was often difficult to define the site of origin. 153 patients (53%) underwent surgical resection which included a modified neck dissection followed by different kinds of reconstruction. 96 patients underwent pharyngogastric anastomosis. Twenty anastomotic leaks (23%) were recorded including both those clinically evident and asymptomatic ones detected radiologically. Moreover, segmental proximal necrosis was seen in ten patients. Hospital mortality rate after pharyngogastric anastomosis was 14.7% (14/95). Colon interposition was used in 11 patients. Two anastomotic leaks and two partial necroses were observed. Hospital mortality was 18% (2/11). Eighteen patients underwent laryngopharyngectomy and cervical oesophagectomy with reconstruction performed by means of revascularized jejunal loop. One anastomotic leak was observed and hospital mortality was nil in these cases. Twenty-four patients underwent total oesophagectomy with larynx preservation when the cancer was located at least 2 cm below the upper oesophageal sphincter. Five anastomotic leaks and two partial necroses occurred and hospital mortality was 8.3% (2/24) in these patients. The remaining five patients operated on underwent miscellaneous surgical procedures with one postoperative death. Overall survival for resections considered curative was 21%:37% for hypopharyngeal and 18% for cervical cancers respectively, while it was nil at three years after palliative resection and total oesophagectomy with larynx preservation.(ABSTRACT TRUNCATED AT 250 WORDS)