Background: Primary esophageal cancer developing after hypopharyngeal or laryngeal cancer is increasing in frequency, but operative treatment of such cases is not well established. The proximity of both cancers could produce interactive influence on surgical procedures and risk factors. There have been few reports focusing on surgical strategy for such cases.
Methods: We retrospectively investigated the most recent series of 18 patients who had previously undergone pharyngolaryngectomy for cancer and subsequently underwent esophagectomy for second primary cancer of the esophagus. At esophagectomy special care was taken to preserve the tracheal vascularity and to select adequate procedures for lymph node dissection and bowel reconstruction.
Results: Curative resection as confirmed macroscopically was achieved in all cases except one. Lymph node involvement was found in half of the patients. No major postoperative complication was observed except for partial necrosis of the trachea in two cases that were conservatively treated. No patient died during hospitalization. The 3-year survival rate was 64% overall and 55% in cases with lymph node involvement.
Conclusions: Although increased operative risk was expected in esophagectomy after pharyngolaryngectomy, our operative results were acceptable. Most risk factors were controllable by selecting appropriate operation procedures. In patients with technically resectable cancer, esophagectomy with systematic lymph node dissection is recommended as in ordinary esophageal cancer.