The head and neck surgeon's role in the management of cervical esophageal cancer

The surgical management of cervical esophageal cancer seems to be a long-standing problem. The thoracic surgeons have centered on the surgery of the intrathoracic esophageal cancer, and most of the patients with cancer of the cervical esophagus were relegated to the irradiation, which brought about a lower survival than surgery did. From 1964 to 1990, 55 patients of cervical esophageal cancer without clinical evidence of hypopharyngeal involvement were treated in the Department of Head and Neck Surgery. The lesions ranged from T2N0 to T4N1 (UICC 1992) with some of the tumour invading the cervical viscera. Total esophagectomy or total laryngopharyngoesophagectomy was performed. Gastric pull-up or colon transplant was used to fill up the alimentary tract defect. In order to resect the whole length of the cervical esophagus and to get a safer upper surgical margin, the cricopharyngeus muscle was cut longitudinally and the postcricoid mucosa was dissected for anastomosis. The 3- and 5-year survivals of this series are 38.2% and 35.0% respectively. Forty-six patients (84%) resumed oral intake of food within one month.