J.Jpn. Surg. Soc.. 102(9): 637-641, 2001

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Feature topic

A NEW TECHNIQUE TO PRESERVE THE LARYNX IN SURGERY FOR CERVICAL ESOPHAGEAL CARCINOMA AND THE LIMIT OF ITS PRACTICAL APPLICATION

A new technique to preserve the larynx in esophagectomy for cervical esophageal carcinoma is described. The trachea, which prevents exposure of the cervical esophagus, is dissected while maintaining the continuity of the recurrent laryngeal nerve. The tracheal stumps were turned over like a double door, and the esophageal tumor is excised with sufficient margins for suturing. The cervical esophagus is safely replaced with a free jejunum or the stomach followed by tracheal reconnection. The technique of tracheal reconnection in the neck is not difficult and is a safe procedure. Anastomotic insufficiency of the trachea may be compensated for with a temporary tracheostomy. This method is applicable in esophagectomy not only with curative but also with palliative intent to offer the patient a better quality of life. Theoretically, this method can be applied even for tumors minimally invading the trachea in which the invaded tracheal segment can be excised in combination with the esophagus, followed by tracheal anastomosis.
Because this technique is a safe and easy procedure, it is recommended in cases in which proximal anastomosis appears difficult.

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