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Treatment outcomes for one-stage concurrent surgical resection and reconstruction of synchronous esophageal and head and neck squamous cell carcinoma

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

It is not uncommon to see the synchronous presentation of esophageal squamous carcinoma (ESCC) and head and neck cancer (HNC), and most patients were treated with staged interventions. This study retrospectively reported the outcomes of patients with synchronous ESCC and HNC treated with one-stage concurrent surgical resection and reconstruction.

Methods

We identified 17 consecutive patients with synchronous ESCC and HNC undergoing primary concurrent surgical resections between 2011 and 2017 at our hospital. All patients had received esophageal screenings prior to treatment.

Results

The HNC patients in this study had the following subsite involvements: oral cavity (n = 5), oropharynx (n = 4), larynx (n = 1), hypopharynx (n = 9), and thyroid gland (n = 1). Eighty percent of the HNC subsites (16/20) were treated in advanced stages, while most ESCCs were treated at early stages. The mean follow-up time was 3.2 ± 1.6 years. Surgery-associated morbidity and mortality were 94.1% and 0%, respectively, and the most common complication was anastomotic leakage. The two-year overall survival, 2-year loco-regional recurrence-free survival, and 2-year distant metastasis-free survival were 86.7%, 85.6%, and 78.7%, respectively. No significant difference was found between overall survival and HNC subsite or anastomotic leakage. Four patients (23.5%) developed secondary primary malignancies (SPMs) within a mean follow-up period of 2.9 years (standard deviation 1.6 years).

Conclusion

Although one-stage concurrent surgical resection and reconstruction of synchronous ESCC and HNC were highly invasive and complicated, survival was promising. Isolated distant metastasis remained the most common failure pattern. Vigilant follow-up strategy is mandatory to detect secondary primary malignancies (SPMs), especially within the first 3 years following initial treatment.

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Abbreviations

ESCC:

Esophageal squamous cell carcinoma

HNC:

Head and neck cancer

SPM(s):

Second primary malignancy(ies)

HPV:

Human papilloma virus

ALDH:

Acetaldehyde dehydrogenase

EGDS:

Esophagogastroduodenoscopy

NAD-CRT:

Neoadjuvant chemoradiotherapy

AJCC:

American Joint Committee on Cancer

CT:

Computed tomography

MR:

Magnetic resonance

PET-CT:

Positron emission tomography computed tomography

FJT:

Free jejunal transfer

ALT:

Anterolateral thigh

GTPU:

Gastric-tube pull-up

OS:

Overall survival

LRFS:

Local regional failure free survival

DMFS:

Distant metastasis-free survival

SD:

Standard deviation

HPC:

Hypopharyngeal cancer

TIL:

Tumor-infiltrating lymphocyte

MMPs:

Metalloproteinases

VEGFR-1:

Vascular endothelial growth factor receptor 1

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Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Yu-Hsuan Lin

  2. Department of Otolaryngology, Head and Neck Surgery, National Defense Medical Center, Taipei, Taiwan

    Yu-Hsuan Lin

  3. Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chun-Yen Ou & Wei-Ting Lee

  4. Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Yao ‐ Chou Lee

  5. Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital Dou‐Liou Branch, College of Medicine, Tainan, Taiwan

    Tzu ‐ Yen Chang

  6. Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Yi-Ting Yen

  7. Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan

    Yi-Ting Yen

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Contributions

L-YH and Y-YT: conception and design. L-YH and Y-YT: collection and assembly of data. L-YH: data analysis and interpretation. L-YH: manuscript writing and final approval of manuscript: all authors.

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Correspondence to Yi-Ting Yen.

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The protocol of this study was approved by the institutional review board of National Cheng Kung University Hospital.

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Lin, YH., Ou, CY., Lee, WT. et al. Treatment outcomes for one-stage concurrent surgical resection and reconstruction of synchronous esophageal and head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 276, 2929–2940 (2019). https://doi.org/10.1007/s00405-019-05564-9

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  • DOI: https://doi.org/10.1007/s00405-019-05564-9

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