Laryngotracheal Autograft for Postcricoid Carcinoma; A Reevaluation

Abstract

Of 84 surgically treated cases of postcricoid carcinoma, 23 had a pharynxesophageal reconstruction by use of a laryngotracheal autograft. This procedure is most suitable in females with manifestations of the Paterson-Broun-Kelly syndrome. The distal esophagus is not “at risk” because of skip areas or second primary lesions. Failures are due predominantly to inability to control the lymphatic metastasis. Stomal recurrence may be due to ascending metastasis from the tracheoesophageal groove and mediastinum. A routine combined neck dissection is urged in all instances. Mediastinal node extirpation with or without resection of the manubrium may increase survival rate. Adequate surgical exposure with visualization, palpation, and exploration of the extent of the cancer is suggested prior to determination of the method of reconsruction of the pharyngoesophagus. In selected cases without previous radiotherapy the laryngotracheal autograft has proved satisfactory.