67 strategy for definitive treatment and preserving quality of life in upper cervical esophageal carcinoma

Abstract In radical surgery for upper cervical esophageal carcinoma, questions such as whether the larynx should be preserved depending on the distance from the esophageal orifice to the tumor margin and risk of aspiration during swallowing arise. We report the clinical outcomes of our strategy for upper cervical esophageal carcinoma based on the goals of curability and larynx preservation. Methods At our institution, resectable upper cervical esophageal carcinoma in which the tumor margin on the oral side is within 3 cm of the esophageal orifice is treated with chemoradiotherapy followed by larynx-preserving esophagectomy. The reason for initially using chemoradiotherapy is to make the surgical margin on the oral side completely negative and as distal as possible for definitive treatment and to improve quality of life (QOL). From 2016 to 2019, there were 24 patients who were diagnosed with upper cervical esophageal carcinoma within 3 cm of the esophageal orifice and received chemoradiotherapy and larynx-preserving esophagectomy. Results All patients were eligible for chemoradiotherapy and larynx-preserving esophagectomy. Pathologically, all surgical margins on the oral side were negative and all operations were curative. In particular, 6 patients with a tumor margin within 1 cm of the esophageal orifice underwent successful curative, larynx-preserving esophagectomy with the following additional techniques: incision of the cricopharyngeus muscle, lifting of the trachea and larynx, and rotation of the larynx to the left. Regarding surgical complications, 4 patients had temporary recurrent nerve paralysis with aspiration pneumonia and 1 patient had minor anastomotic leakage. Conclusion The combination of chemoradiotherapy and esophagectomy with a larynx-preserving technique is a useful treatment strategy for upper cervical esophageal carcinoma in terms of both definitive treatment and QOL.