Voice preservation in postcricoid and cervical esophageal cancer

Y. P. Krespi, G. A. Sisson and C. F. Wurster

Total laryngopharyngectomy has been the standard surgical treatment for postcricoid and cervical esophageal cancer. Of patients undergoing standard laryngectomy, 30% will develop esophageal speech and a substantial number of the remainder can be rehabilitated by use of the electrolarynx or tracheoesophageal puncture. However, the vast majority of patients who undergo laryngopharyngectomy with current methods of reconstruction remain voiceless. Reconstruction of the hypopharynx and cervical esophagus has been a formidable challenge to head and neck surgeons. Various types of reconstruction have been used: skin grafts, local neck flaps, deltopectoral flaps, free bowel grafts, myocutaneous flaps, etc. Gastric pull-up reconstruction of the hypopharynx and cervical esophagus is superior to other methods. A new technique uses this procedure, allowing immediate vocal rehabilitation. Five patients underwent pharyngolaryngoesophagectomy for malignant lesions of the postcricoid area and/or cervical esophagus. Reconstruction of the digestive tract using the stomach and immediate voice restoration by a tracheogastric shunt retaining the anterior half of the larynx and upper part of the trachea represent a new surgical method after pharyngolaryngoesophagectomy.