BACKGROUND: Gastric pull-up is a useful method for reconstruction of the upper digestive tract, with considerable morbidity/mortality, especially in esophageal cancers (EC)
OBJECTIVE: To analyze the experience of a multidisciplinary team with a laparoscopic gastric pull-up (LGPU) method, with or without thoracoscopy, in a series of 120 patients with EC.
STUDY DESIGN: Retrospective.
PATIENTS AND METHODS: From 1992 to 2004, 120 EC [cervical/cervicothoracic (3.0%), middle third (15.0%), and inferior third (82.0%)]. Most were squamous cell carcinomas (47.0%) and adenocarcinomas (34.0%). Stomach was dissected and mobilized exclusively by laparoscopy. Occasionally, laparoscopic approach was extended cranially, until connecting with cervical dissection. In other cases, dissection of thoracic esophagus was accomplished through a thoracoscopic approach.
RESULTS: Eighty-one patients (68.0%) had LGPU; 39 (32.0%) needed thoracoscopy. Mortality was 5.9%. Complications were fistula (10.0%) and pneumonia (10.0%). All fistulae closed spontaneously; 89.2% of patients could swallow a normal oral diet.
CONCLUSION: Low morbidity/mortality of LGPU for EC compared favorably with conventional techniques.
Get full access to this article
View all access options for this article.
References
1.
LefebvreJLChevalierDLuboinskiB, et al. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst1996; 88: 890–9.
2.
WeiWIShamJST.Extent of resection of hypopharyngeal cancer. In: WeiWIShamJST, editors. Cancer of the larynx and hypopharynx. Oxford, UK: Isis Media Medical Ltd.; 2000. p. 95–104.
3.
BakamjiamVY.A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg1965; 36:173–84.
4.
AriyanS.The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg1979; 63: 73–81.
5.
HallerJR.Concepts in pharyngoesophageal reconstruction. Otolaryngol Clin North Am1997;30:655–61.
6.
GendenEMJacobsonAS.The role of the anterolateral thigh flap for pharyngoesophageal reconstruction. Arch Otolaryngol Head Neck Surg2005;131:796–9.
7.
YuP.One-stage reconstruction of complex pharyngoesophageal, tracheal, and anterior neck defects. Plast Reconstr Surg2005;116:949–56.
8.
Morais-BesteiroJCerneaCRdos SantosLR, et al. Microvascular flaps in head and neck reconstruction. Head Neck1990;12:21–30.
9.
KrollSSSchustermanMAReeceGP, et al. Choice of flap and incidence of free flap success. Plast Reconstr Surg199; 98: 459–63.
10.
LewinJSBarringerDAMayAH, et al. Functional outcomes after circumferential pharyngoesophageal reconstruction. Laryngoscope2005;115:1266–71.
11.
MehtaSASarkarSMehtaAR, et al. Mortality and morbidity of primary pharyngogastric anastomosis following circumferential excision for hypopharyngeal malignancies. J Surg Oncol1990;43:24–7.
12.
ShriverCDSpiroRHBurtM.A new technique for gastric pull-through. Surg Gynecol Obstet1993;177:519–20.
13.
AyshfordCAWalshRMWatkinsonJC.Reconstructive techniques currently used following resection of hypopharyngeal carcinoma. J Laryngol Otol1999;113:145–8.
14.
ChuPYChangSY.Reconstruction after resection of hypopharyngeal carcinoma: comparison of the postoperative complications and oncologic results of different methods. Head Neck2005;27:901–8.
15.
StaleyCAMillerMKingTJ, et al. Laparoscopic intracorporeal harvest of jejunal tissue for autologous transplantation. Surg Laparosc Endosc1994;4:192–5.
16.
WadsworthJTFutranNEubanksTR.Laparoscopic harvest of the jejunal free flap for reconstruction of hypopharyngeal and cervical esophageal defects. Arch Otolaryngol Head Neck Surg2002;128:1384–7.
17.
DePaulaALHashibaKFerreiraEA, et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc1995;5:1–5.
18.
LawSYFokMWeiWI, et al. Thoracoscopic esophageal mobilization for pharyngolaryngoesophagectomy. Ann Thorac Surg2000 Aug; 70(2):418–22.
19.
HujalaKSipilaJGrenmanR.Panendoscopy and synchronous second primary tumors in head and neck cancer patients. Eur Arch Otorhinolaryngol2005;262:17–20.
20.
AvitalSZundelNSzomsteinS, et al. Laparoscopic transhiatal esophagectomy for esophageal cancer. Am J Surg2005;190:69–74.
