Introduction
Total pharingo-laryngo-esophagectomy (TPLE) represents the main salvage surgical procedure for cervical esophageal cancer involving the hypopharynx after failed definitive chemoradiation. It is an extremely demolishing, technically challenging and high-risk procedure. We report a series of transthoracic totally minimally invasive TPLEs with gastric pull-up reconstruction in a referral center for esophageal surgical oncology.
Methods
We retrospectively reviewed medical records of 12 patients undergoing TPLE in our institution from January 2018 to October 2023 from a prospectively collected database. The operation was performed by two teams of esophagogastric surgeons and otolaryngology surgeons: esophagogastric surgeons performed thoracoscopic esophageal dissection and thoracic lymphadenectomy, laparoscopic lymphadenectomy and gastric conduit fashioning with a service mini-laparotomy, feeding jejunostomy and pharyngo-gastric anastomosis, while otolaryngology surgeons performed pharyngo-laryngectomy and cervical lymphadenectomy.
Results
12 patients underwent TPLE during the study period. Indication was salvage surgery for persistent/recurrent SCC of the cervical esophagus involving the hypopharynx in 11 patients (91.7%), and thyroid cancer involving the larynx and the cervical esophagus in one case (8.3%). Median age at surgery was 65.5 years (range 41-80). Most patients were female (10, 83.3%). Ten patients underwent definitive chemoradiation (83.3%). Median interval between chemoradiation and surgery was 11 months (range 3-232). In-hospital mortality was 0%, major complications rate (CD>2) was 25%, anastomotic leak rate occurred in 2 patients (16.7%), mean length of hospital stay was 36 days (17-86). Eight patients are alive and disease free with a median follow-up time of 15 months (1-59).
Conclusions
Salvage transthoracic totally minimally invasive TPLE, despite the high morbidity rate, is feasible and safe within a multidisciplinary surgical team in a referral center for esophageal surgery, and can be curative for persistent or recurrent cervical esophageal cancer involving the hypopharynx after definitive chemoradiation.

Salvatore Marano

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