Primary carcinoma of the hypopharynx and cervical esophagus: evolution of surgical therapy.

Carcinoma of the cervical esophagus is invariably fatal because of its advanced stage at presentation. In our surgical division, 167 patients with primary squamous-cell carcinoma of the cervical esophagus were treated over the period between 1973 and June 1992. The tumor was localized in the cervical esophagus in only 37 cases, whereas it also involved the hypopharynx in 112 patients or extended to the cervico-thoracic segment in the remaining 18 subjects.

Esophagectomy and esophageal replacement by gastric pull-through procedure.

The gastric pull-through procedure is a relatively new surgical technique for carcinomas of the hypopharynx and cervical esophagus and benign diffuse stricture of the thoracic esophagus, that require total esophagectomy. This technique is original both in the exeretic and reconstructive phase: total esophagectomy is performed by blunt dissection; thoracotomy and pleural damage are avoided. The basic principle of the operation is the gastric transposition into the neck through the posterior mediastenum and a pharyngogastric or esophagogastric anastomosis, according to the type of disease.