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A third decade's experience with the gastric pull-up operation for hypopharyngeal carcinoma: changing patterns of use

  • B. E. J. Hartley (a1), I. D. Bottrill (a1) and D. J. Howard (a1)


Gastric transposition has been used extensively in this department since 1965 for reconstruction following pharyngolaryngoesophagectomy (PLO). A previous report by Harrison and Thompson in 1986 detailed our experience with 101 cases dating back to 1965. Here we review our experience between 1986–1996.

Medical records of 41 cases were examined. The primary site and stage of tumour and associated lymph nodes, patient demographics, complications, in-patient mortality and survival as demonstrated by the Kaplan-Meier method were recorded.

Gastric transposition is now used for more extensive tumours: 70 per cent T4 (83 per cent pathologically T4) compared to 21 per cent in the previous report. A high proportion of ‘radiation failures’ remains (54 per cent). The in-hospital mortality has fallen from 11 per cent to seven per cent. The five-year-survival calculated using the Kaplan-Meier method is 11 per cent.

This procedure is increasingly being used as a palliative procedure aiming to restore swallowing in the relatively young patient who has very extensive hypopharyngeal carcinoma. Long-term survival rates specific to this operation have fallen. This is attributed to patient selection for the procedure with the vast majority having disease extending into bone, cartilage or soft tissues (T4). The defect created by the resection of less extensive tumours are now increasingly reconstructed with jejunal free flaps and musculocutaneous flaps.


Corresponding author

Address for correspondence: B. E. J. Hartley, ENT Dept, Charing Cross Hospital, Fulham Palace Road, London W6 8RF. Fax: 0181 846 1070


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Harrison, D. F. N. (1979) Surgical management of hypopharyngeal cancer. Archives of Otolaryngology 105: 149152.
Harrison, D. F. N., Thompson, A. E. (1986) Pharyngolaryngoesophagectomy with pharyngogastric anastomosis for cancer of the hypopharynx: review of 101 operations. Head and Neck Surgery 8: 418428.
Ho, C. M., Lam, K. H., Wei, W. I., Yuen, P. W., Lam, L. K. (1993) Squamous cell carcinoma of the hypopharynxanalysis of treatment results. Head and Neck 15: 405412.
Jones, A. S., Roland, N. J., Husband, D., Hamilton, , Gati, I. (1996) Free vascularized jejunal loop repair following total pharyngolaryngectomy for carcinoma of the hypopharynx: report of 90 patients. British Journal of Surgery 83: 12791283.
Ong, G. B., Lee, T. C. (1960) Pharyngogastric anastomosis after oesophagopharyngectomy for carcinoma of the hypopharynx and cervical oesophagus. British Journal of Surgery 48: 193200.
Sasaki, C. T., Salzer, S. J., Cahow, C. E., Yung, S., Ward, B. (1995) Laryngopharyngoesophagectomy for advanced hypopharyngeal and esophageal squamous cell carcinoma: the Yale experience. Laryngoscope 105: 160163.
Schuller, D. E. (1983) Pectoralis myocutaneous flap in head and neck cancer reconstruction. Archives of Otolaryngology 109: 185189.
Spiro, R. H., Shah, J. P., Strong, E. W., Gerold, F. P., Bains, M. S. (1983) Gastric transposition in head and neck surgery. American Journal of Surgery 146: 483487.
Stell, P. M., Missotten, F., Singh, S. D., Ramadan, M. F., Morton, R. P. (1983) Mortality after surgery for hypopharyngeal cancer. British Journal of Surgery 70: 713718.
Stell, P. M., Morton, R. P. (1982) ‘Average’ survival times after treatment of cancer. Clinical Oncology 8: 293303.
Turner, G. (1936) Carcinoma of the oesophagus: the question of its treatment by surgery. Lancet 1: 130134.
Yuen, A. P. W., Wei, W. I., Hui, Y., Ho, W. K. (1996) Comprehensive analysis of pharyngeal recurrence of laryngeal carcinoma after total laryngectomy. American Journal of Otolaryngology 17(60): 380385.



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