Clinical Results of Salvage Surgery in Hypopharyngeal, Cervical Esophageal and Laryngeal Cancer after Chemoradiotherapy

Abstract

Recently CRT, which helps retain the function and shape of the head and neck, has been provided in the field of head and neck cancer treatment. However a few recurrence cases have been reported, and salvage surgery should be performed in such cases. We recorded all complications with salvage surgery and compared CRT cases and simple RT or non-RT cases during the same time frame. We examined a total of 299 cases, including hypopharyngeal carcinoma (189cases), laryngeal carcinoma (82cases), and cervical esophageal carcinoma (28cases), that were given total laryngectomy or total pharyngo-laryngo-esophagectomy between April 2005 and August 2009. We classified them as CRT (22cases), simple RT (31cases) or non-RT (242cases), and subdivided these into 3 types : severe (carotid artery rupture), moderate (major fistula), and light (minor fistula). The results showed that among the CRT cases, 19.2% were severe, 11.5% were moderate, 19.2% were light, and 53.8% had no complications. Among the simple RT cases, 6.5% were severe, 6.5% were moderate, 16.1% were light, and 74.2% had no complications. Among the non-RT cases, 3.3% were severe, 3.3% were moderate, 9.1% were light, and 85.6% had no complications.
A significant difference (p=0.0003) in frequency of complication development was seen between CRT cases and non-RT cases. Because we can not avoid the risk of the complications developing during salvage surgery, we must offer salvage surgery with an explanation of attendant risks and secure patient agreement in all cases.