Multidisciplinary Surgery for Broncho-esophageal Diseases. Surgery for Hypopharyngeal and Cervical Esophageal Carcinoma Requiring Multiple Specialities.

Among 254 patients undergoing resection of hypopharyngeal and cervical esophageal carcinoma since 1972, muscle, fasciocutaneous or musculocutaneous flaps were used in 26 cases. Free intestinal grafting was performed in 28 patients. The surgical treatment of these patients which required plastic surgery techniques was reviewed.The combination of extended lymph node dissection of the superior mediastinum via right thoracotomy and median sternotomy, laryngopharyngectomy, and permanent tracheostomy can lead to friction between the brachiocephalic artery and the trachea, with a risk of lethal fistula formation between the two structures. Pectoralis muscle interposition between these two structures is an important, but not infallible, technique for preventing this lethal complication. Ischemic necrosis of the trachea and preoperative radiation are risk factors. Grillo's operation was successfully done in 8 patients. Pectoralis musculocutaneous flaps were used in 7 patients for reconstruction, and a latisimus dorsi muscle flap was used in 1 patient. Free intestinal grafting is a useful technique, but great care should be taken to avoid leaving another malignant lesion in the residual esophagus in the thorax.When surgeons of various specialities work together on a patient with hypopharyngeal or cervical esophageal cancer, detailed preoperative discussion and flexible intraoperative judgments can help achieve success.