日本気管食道科学会会報

Patients with head and neck cancer have been reported to be at high risk of developing esophageal cancer. We have performed esophageal endoscopy with iodine staining as one of the follow-up examinations for head and neck cancer patients. A second, primary esophageal cancer was found in 5 of 72 cases (6.9%). These were relatively early cancers compared to the esophageal cancer found in patients with pharyngolaryngeal discomfort. Iodine staining, especially, revealed the presence of very early cancer. Thus, esophageal endoscopy with iodine staining can be very important as a screening method for early esophageal cancer in head and neck cancer patients.

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A 57-year-old woman visited our hospital complaining of a dyspnea feeling. A tumor was revealed in the posterior wall of the trachea by laryngoscopy. The tumor was shown to have a developed from the trachea by CT and MRI findings. Since a biopsy from the tumor by tracheobronchoscopy for pathological diagnosis poses certain risks, such as bleeding and dyspnea, fine needle aspiration biopsy under ultrasonography was first performed, and the pathological diagnosis was adenoid cystic carcinoma. After intubating the trachea with a thin intubation tube for general anesthesia, the tracheostomy was performed, and then the procedure was switched to intratracheal intubation a with normal-sized tube. A tracheo-laryngectomy was performed with a safety margin. This suggests that fine needle aspiration biopsy can be a safe and useful method for tracheal tumors.

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Twenty four cases of unilateral laryngeal paralysis were examined by contrast laryngography. The characteristic feature of the laryngeal paralysis in these contrast laryngogram was that the vocal fold on the affected side was fixed in the half adducted position during respiration. This corresponded to the laryngoscopic view of the vocal fold fixed at the intermediate position. During phonation, the larynx was seen to be elevated, and the shape of the laryngeal cavity changed. However, the tracheal portion of the vocal tract did not change on the contrast laryngogram. When the contrast laryngograms taken during respiration and phonation were superimposed at the unchanging tracheal portion, the movement of the vocal folds could be measured and quantified. The vocal fold on the affected side was slightly adducted during phonation in 10 out of the 24 cases of unilateral paralysis, and abducted in 2 cases (paradoxical movement due to misdirected regeneration of the recurrent laryngeal nerve) and fixed in the rest 12 cases. The position of the vocal fold on the affected side during phonation was related to its mobility. When it was slightly adducted, it seemed to be fixed at the paramedian position in the laryngoscopic examination. When it was not adducted, it was fixed at the intermediate position.

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Pharyngolaryngo-esophagectomy and pharyngogastric anastomosis (PLO & PGA) is one of the surgical options in the management of tumors located at the hypopharyngeal and cervical esophageal region. Over the years, indications of this operation have changed and so are the results. The experience of performing this operation in our Institute over the last thirty years was reviewed to entablish the present status of this operation.
A total of 317 patients underwent the operation PLO & PGA from 1966 to 1995 in the department of surgery, University of Hong Kong Medical Center, at Queen Mary Hospital, Hong Kong. The clinical results of 69 patients operated on between 1986 and 1995 were analyzed in detail and compared with that of patients in the two periods reported previously from the same Institute, to show the changing trend.
During the seventies and eighties, for those who underwent the operation, in 53% of them, the primary tumors were advanced laryngeal carcinomas extending to the hypopharynx, while for the other 47% patients, their primary tumor were hypopharyngeal and cervical esophageal malignancies. In recent years, all patients belonged to the latter group.
Over the years, the hospital mortality has decreased from 31% to 9% and the incidence of bleeding, anastomosic leakage and other major morbidities have also reduced from 20% to 10%. These are likely to be related to patient selection and some technical modifications. The latter include the introduction of transthoracic endoscopic mobilization of the esophagus and the various measures to produce a tensionless anastomosis at the pharyngogastric suture line. The overall minor morbidity has, however, remained at around 49% and the 5-year actuarial survival rate following this operation has improved from 18% in the seventies to 24.5% recently.

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