Functional Outcomes and Nutrition in Patients Undergoing Pharyngo-Laryngo-Esophagectomy with Laparoscopic Gastric Transposition

Abstract

Objectives:

Explore functional outcomes and nutrition in patients undergoing pharyngo-laryngo-esophagectomy with laparoscopic gastric transposition.

Methods:

A retrospective case-note review of patients who have undergone pharyngo-laryngo-esophagectomy with laparoscopic gastric transposition for squamous cell carcinoma of the hypopharynx between 1/2/2010 and 31/1/2013 at a tertiary referral center. History, anthropometrics, length of admission, biochemical markers, nutritional requirements, provision, complications, readmission, pre-operative voice quality, timeframes to secondary TOP, perceptual measures of TOP speech, normalcy of diet and public eating performance status score were collated.

Results:

Eight patients, mean age of 55 at operation. Voice outcome: The timeframe from surgery to completion of a secondary puncture was approximately one calendar year. One patient has functional hypotonic voice 3 years post-op. Nutrition: Pre-operative nutritional support was inconsistent. Patients had a jejunal (JEJ) feeding tube inserted at the time of surgery. Post-operatively patients were nil by mouth with JEJ feeding being commenced between day 1 and 12. Mean body mass index at 6 months and 3 years 20.8kg/m2 and 19.65 kg/m2 (latter in 2 patients of 3 survivors). Swallowing: Mean pre-operative PSS scores for normalcy of diet and public eating were 30/100 and 50/100 respectively. Dysphagia was an issue for all patients post-operatively with none achieving normalcy of diet PSS levels >50/100. Following surgery compared with pre-operative scores, all public-eating scores reduced.

Conclusions:

Voice restoration and swallowing functions are reduced following surgery. Pre- and post-operative nutritional support is essential. We believe our experience over 3 years is the longest and largest case series review of functional outcomes worldwide.