[Surgical treatment of advanced laryngeal cancer with preservation of laryngeal function].

OBJECTIVE: To explore the surgical methods for advanced laryngeal cancer and long term effects of laryngectomy. METHODS: Two hundred and thirty-eight cases of laryngeal cancer at different stages, including 103 cases with supraglottic cancer, 118 cases with glottic cancer, 3 cases with subglottic cancer, and 14 cases with recurrent cancer, underwent different kinds of operation from 2000 to 2010. The TNM classifications were as follows: T3 168 cases, T4 70 cases. Stage III 145 cases, Stage IV 93 cases. N0 134 cases,N1 64 cases,N2 38 cases, and N3 2 cases. The effects of operation, especially with the preservation of laryngeal function, was analyzed. The disease-free survival rate was calculated by Kaplan-Meier methods. RESULTS: Partial laryngectomy was performed on 142 of the 238 cases (59.7%). Total laryngectomy was performed on 96 cases. In 142 patients who received partial laryngectomy with preservation of laryngeal function, the trachea cannula was extracted in 90 patients, with the decannulation rate as 63.4%. The nasal feeding tube was removed and peroral feeding was recovered in all patients. The patients undergoing partial laryngectomy succeeded in phonation. The 3 years and 5 years disease-free survival rates in all patients were 81.4% and 59.5%. The 3 years and 5 years disease-free survival rate of partial laryngectomy were 82.9% and 64.3%. The 3 years and 5 years disease-free survival rates in total laryngectomy were 79.2% and 52.4%. There was no significantly different between the two groups (χ(2) = 2.478, P = 0.115). CONCLUSION: For the advanced laryngeal cancer, it is possible to preserve the laryngeal function without compromising the remote survival rate by detailed pre-operational estimation, properly selected operation and skilled surgical practice.

[Association between lymphangiogenesis and clinicopathological features and prognosis in laryngeal carcinoma].

OBJECTIVE: To detect lymphangiogenesis by labeling the lymphatic endothelial marker, lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1), and study the prognostic relevance of lymphangiogenesis in laryngeal squamous carcinoma. METHODS: Clinical files and specimens of 78 patients with histologically diagnosed laryngeal carcinoma were stained with LYVE-1 as a specific lymphatic endothelial marker. The lymphatic vessel density (LVD) was measured, and the correlation between LVD and clinicopathological features of the tumor cases was analyzed. RESULTS: The mean LVD in laryngeal carcinoma (13.24 ± 5.09) was significantly higher than that in adult laryngeal papilloma (5.54 ± 3.15) and squamous dysplasia (6.76 ± 4.45, P < 0.05). The LVD of poorly differentiated tumors (15.74 ± 5.24) was significantly higher than that in the moderately differentiated tumors (13.84 ± 6.20), and the LVD in the moderately differentiated tumors was significantly higher than that in the well-differentiated tumors (11.68 ± 6.34). The LVD in stage 0 to stage II group (10.66 ± 5.70) was significantly lower than that in the stage III to IV group (17.01 ± 6.35). The lymph node metastasis group (17.25 ± 7.37) was significantly higher than non-lymph node metastasis group (8.60 ± 5.23, P < 0.05). There was no significant association between LVD and age, sex, primary site and distant metastasis. The overall survival in the patients with a LVD higher than the mean value was 33.5 month, and that of cases with a LVD lower than the mean value was 81.6 month (P < 0.05). The multivariate survival analysis showed that the clinical stage and LVD were independent prognostic factors of laryngeal cancer. CONCLUSIONS: The LYVE-1 staining histochemistry demonstrates that the lymphangiogenesis occurrs mainly at the edge of the tumors, and lymphangiogenesis plays an important role in the carcinogenesis, cancer progression and lymph node metastasis in laryngeal cancer. LVD may be an independent indicator of poor prognosis of laryngeal cancer.

[Comprehensive treatment of 352 cases with hypopharyngeal cancer].

OBJECTIVE: To review the experience of different surgical construction methods and comprehensive treatments for hypopharyngeal cancer. METHODS: Three hundred and fifty-two cases (According to UICC 2002 criteria, stage I, 3; II, 31; III, 134; IV, 184) with hypopharyngeal cancer were retrospectively reviewed from 1999 to 2005 in the Department of Otorhinolaryngology of Qilu Hospital of Shandong University, including 321 males and 31 females. The median age was 58 years old, ranged from 26 to 82 years old. All the tumors originated from the pyriform sinus (272), posterior pharyngeal wall (61), postcricoid area (19). There were no distant metastasis. Two hundred and fourty-one cases were surgically treated with laryngeal functions preserved and 111 cases without laryngeal functions preserved. All the patients received modified neck dissection, including both unilateral (247 patients) and bilateral (105 patients). Pharyngoesophageal defect reconstruction methods in cases with laryngeal functions preserved were: direct suture in 137, pectoralis major musculocutaneous flap in 62, split graft in 2, pectoralis major musculocutaneous flap combined with the split graft in 5, stomach pulling-up in 12, colon interposition in 23 patients. While in cases without laryngeal functions preserved the methods includes: direct suture in 54, laryngotracheal flap in 54 patients, pectoralis major musculocutaneous flap in 7, laryngotracheal flap combined with pectoralis major musculocutaneous flap in 8, stomach pulling-up in 22, colon interposition in 3 patients. All patients received radiotherapy postoperatively (dose 55 - 75 Gy). RESULTS: The overall 3 and 5 year survival rates were 65.1% (229/352) and 53.6% (142/265), respectively. For stage I, the 5 year survival rate was 3/3, stage II, 80.6%(25/31), stage III, 65.0% (67/103), stage IV, 36.7% (47/128). The 3 and 5 year survival rates in functionally preserved group were 68.0% (164/241) and 59.7% (114/191), respectively, while in non-functionally preserved group were 58.6% (65/111) and 37.8% (28/74), respectively. The cervical lymph node metastasis was found in 239 sides. Pathologic findings showed that well, moderately and lower differentiated squamous cell carcinomas were 84, 163, 105 cases, respectively. Laryngeal functions (voice, respiration and deglutition) were completely restored in 169 patients and partially restored (voice and deglutition) in 72 patients. CONCLUSIONS: Combined surgery and radiotherapy are the best choice for hypopharyngeal cancer. The continuity of the pharyngoesophagus is restored and the laryngeal function is preserved as far as possible. The preservation of laryngeal function and the laryngeal and pharyngeal reconstruction are based on the premise that the tumor was excised completely.

Therapeutic influence on circulating and monocyte-derived dendritic cells in laryngeal squamous cell carcinoma patients.

CONCLUSION: Surgical resection of laryngeal squamous cell carcinoma (LSCC) could be associated with improved circulating myeloid dendritic cell (mDC) number and monocyte-derived dentritic cell (MoDC) function. Although adjunctive radiotherapy after surgery did not effect the normalization of mDC number, it may have an impact on MoDC function. OBJECTIVE: To investigate the effects of surgery and adjunctive radiotherapy on both circulating dendritic cells (DCs) and MoDCs of LSCC patients. SUBJECTS AND METHODS: Forty-six patients with LSCC and 15 age-matched healthy control subjects were enrolled in this study. Blood samples were taken before, during, and after conventional treatment from both patients who underwent surgery only (n=18) and those who had adjunctive radiotherapy after tumor removal (n=28). Three-color flow cytometry was used for determination of circulating DC subsets. Moreover, MoDCs were generated utilizing granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4), then the phenotype of MoDCs was measured by flow cytometry and the ability to stimulate autologous T cells was tested in a mixed leukocyte reaction (MLR). RESULTS: The preoperative mDC counts, MoDC surface molecular expression and stimulatory capacity were impaired in patients in comparison with controls. The number of mDCs and the expression of CD80, CD83, and HLA-DR on MoDCs were significantly increased as compared with those pretreatment in patients who underwent surgery only and in those who had surgery followed by adjunctive radiotherapy. However, the recovery of CD86 expression and allostimulatory activity was only observed in patients who underwent surgery alone.

Suppression of survivin expression by short hairpin RNA induces apoptosis in human laryngeal carcinoma cells.

PURPOSE: The aim of this study was to evaluate the suppression effect of survivin shRNA on the expression of the survivin gene in the human laryngeal cancer cell line Hep-2. PROCEDURES: 60 cases of laryngeal squamous-cell carcinoma (LSCC) and 10 cases of normal laryngeal mucosa were examined using immunohistochemistry to determine whether the expression of survivin correlated with tumorigenesis. Three plasmid vectors of short hairpin RNA (shRNA) specific for survivin were designed and generated. Western blot and real-time PCR analysis of survivin expression in Hep-2 cells was performed 48 h after transfection. The growth curve was used to determine the cell proliferation. Propidium iodide (PI) single staining was applied to detect the cell cycle. The apoptosis of the cells was analyzed by flow cytometry with the FITC-annexin-V/PI double staining and PI single staining. RESULTS: 68.33% (41 out of 60) of tumors were positive for survivin expression and significantly associated with lymph node metastasis and advanced stage. In contrast, no expression of survivin in normal mucosa was detected. Transfection of Hep-2 cells with survivin shRNA significantly inhibited survivin expression at both the mRNA and the protein level in Hep-2 cells. Downregulation of survivin resulted in increasing the apoptosis index, but the results showed no obvious influence on cell cycle. CONCLUSIONS: This study demonstrates that survivin shRNA effectively inhibits survivin gene expression in Hep-2 cells leading to growth suppression and apoptotic induction in Hep-2 cells.

[Surgical management and preservation of laryngeal function for senile patients with advanced laryngeal carcinoma].

OBJECTIVE: To explore the methods of surgical treatment and preservation of laryngeal function in senile patients with advanced laryngeal carcinoma. METHODS: A retrospective data review of 87 advanced laryngeal carcinoma patients aged over 65 years was carried out. Of these 87 patients treated by different modes of surgery, 48 had supraglottic cancer, 35 glottic cancer and 4 subglottic cancer. The surgery modes consisted of major partial laryngectomy in 36 patients, subtotal partial laryngectomy with laryngoplasty in 21 and total laryngectomy in 30. All patients received postoperative radiotherapy to a dose of 50-60 Gy. Kaplan-Meier method was used to analyze the survival. RESULTS: The overall 3- and 5-year survival rate was 73.2% and 67.4%, respectively. The ultimate rate of larynx preservation was 65.5%. Of 57 patients with partial laryngectomy, 46 were decannulated with a decannulation rate of 80.7%. Yet, in all patients, the nasal feeding tube was removed and food intake per os was resumed. All patients who underwent partial laryngectomy regained their phonation function. CONCLUSION: It is safe and effective to treat and preserve laryngeal function surgically in the senile patients with advanced laryngeal carcinoma. The key points to achieve this are selection of proper patient, renovation of surgical procedure and improvement of surgical skill.

[Surgical treatment of hypopharyngeal cancer with cervical esophageal invasion].

OBJECTIVE: To review the experience of different surgical construction methods for hypopharyngeal cancer with cervical esophageal invasion. METHODS: From 1989 to 2000,forty-eight patients with advanced hypopharyngeal cancer and cervical esophageal invasion were retrospectively reviewed, including 38 males and 10 females. The median age was 54. 3 years old, ranged from 26 to 71 years old. According to UICC 1997 criteria, all the tumors were T4 stage and originated from the pyriform sinus (33), posterior pharyngeal wall (14), postcricoid area (1), there were 28 patients in cN0, 15 in cN1, 5 in cN2 and no distant metastasis. Precise preoperative evaluation was performed with computed tomography scan, barium swallow perspective and biopsy. All the patients received modified neck dissection, including both unilateral (38 patients) and bilateral (10 patients). Pharyngoesophageal defect reconstruction methods were: laryngotracheal flap in 11 patients, pectoralis major musculocutaneous flap in 13, laryngotracheal flap combined with pectoralis major musculocutaneous flap in 6, pectoralis major musculocutaneous flap combined with the split graft in 10, stomach pulling-up in 3, colon interposition in 5 patients. Total laryngectomy was carried out in 8 patients. All patients received radiotherapy postoperatively (dose 55 - 75 Gy). RESULTS: The cervical lymph node metastasis was found in 20 patients. Pathologic findings showed that well, moderately and lower differentiated squamous cell carcinomas were 18, 24, 6 cases, respectively. The overall 3 and 5 year survival rates were 52.1% (25/48) and 27.3% (12/44), respectively. The 3 and 5 year survival rates in functionally preserved group were 65.2% (15/23) and 33.3% (7/21), while in non functionally preserved group were 40.0% (10/25) and 21.7% (5/23), respectively. Fifteen patients laryngeal functions (voice, respiration and deglutition) were completely restored and 8 patients partially restored (voice and deglutition). The decannulation rate was 65% (15/23). The complication included pharyngeal fistulas in 10 cases and splitting of chest wall in 1 cases. CONCLUSIONS: Combined therapy was the best choice for hypopharyngeal cancer with cervical esophageal invasion. The laryngeal function is preserved as far as possible. The continuity of the pharyngoesophagus was restored by pectoralis major musculocutaneous flap, laryngotracheal flap, or combined with the split graft. Stomach transposition or colon interposition was used while the defect of the esophagus was greater.

[Surgical treatment of postcricoid carcinoma].

OBJECTIVE: To explore the surgical techniques in surgical treatment of postcricoid carcinoma. METHODS: Twenty-one cases with postcricoid carcinoma were treated surgically. The TNM stage were as follows: T3NOM0 5 cases, T3N1M0 1 case, T3N2M0 2 cases, T4NOM0 7 cases, T4N1M0 4 cases, T4N2M0 1 case, T4N3M0 1 case. The laryngeal and pharyngeal functions were rebuilt by the remaining tissue when the lesions entirely removed. Ten cases were surgically treated with laryngeal functions preserved and 11 cases with total laryngectomy. Eight cases were received unilateral neck dissection, and 3 cases were received bilateral neck dissection. All the cases received postoperative radiotherapy. RESULTS: The follow-up interval varied from 60 to 276 months with average interval 96 months. Four cases died of cervical metastasis,3 died of local recurrence, 1 died of cardiopulmonary failure, 2 died of unknown reasons. The overall 3 and 5 year survival rates were 61.9% (13/21) and 52.4% (11/21), respectively. Among 10 cases having laryngeal functions partially restored (voice and deglutition), the postoperative complications included 5 cases of pharyngeal fistula, 3 hypopharyngeal stenosis and 1 severe aspiration. CONCLUSIONS: The preservative surgery is feasible for the selected cases with postcricoid carcinoma. The laryngeal function can be partially restored with lesions entirely removed. The patients can gain satisfied survival rate and quality of life.

[Preservation of laryngeal function in surgical treatment of pyriform sinus carcinoma].

OBJECTIVE: To explore the feasibility and the related surgical techniques of laryngeal function preservation in surgical treatment of pyriform sinus cancer. METHODS: Two hundred and thirty cases (stage I, 6; stage II, 10; stage III, 91; stage IV, 123) with pyriform sinus cancer were treated surgically from 1978 to 1996 in the Department of Otorhinolaryngology of Qilu Hospital of Shandong University. The methods of removing tumor and repairing surgical defects were depended on the extension of lesions. The laryngeal and pharyngeal functions were rebuilt by normal tissue preserved with lesions entirely removed. One hundred and fifty-eight cases were surgically treated with laryngeal functions preserved and 72 cases total laryngectomy. The most of the cases received postoperative radiotherapy. RESULTS: The overall 3 and 5 year survival rates were 67.4% (155/230) and 48.3% (111/230) respectively. For stage I, the survival rate was 5/6; stage 11, 70.0% (7/10); stage III, 57.1% (52/91) and stage IV, 38.2% (47/123); the 3 and 5 year survival rates in functionally preserved group were 67.7% (107/158) and 50.0% (79/158), while in none functional group were 66.7% (48/72) and 43.1% (31/72), respectively. 75.3% (119/158) patients have laryngeal functions (voice,respiration and deglutition) completely restored and 24.7% (39/ 158) partially restored(voice and deglutition). CONCLUSIONS: The preservative surgery is feasible for the selected pyriform sinus cancer cases. Choosing and following optimum surgical methods is a prerequisite for improving the quality of life of the cases.

[Validity of high negative pressure drainage for chylous fistula after neck dissection: a report of eight cases].

BACKGROUND & OBJECTIVE: Chylous fistula, a severe complication after operation on neck, has close correlation with definite anatomical position and variation. Its treatment remains controversial. This study was to evaluate the validity of high negative pressure drainage for chylous fistula after neck dissection. METHODS: A treatment of high negative pressure (-30 to -50 kPa) drainage, fasting, and reasonable venous nutrition was applied to 8 patients with postoperative chylous fistula. RESULTS: Of the 8 patients, 7 recovered smoothly without severe complication, and pectoralis major muscle flap was adopted to cure the failed one. CONCLUSION: A treatment of high negative pressure drainage and reasonable diet is effective and safe for chylous fistula at early stage.

[Surgical management of aged patients with hypopharyngeal carcinoma and preservation of laryngeal function].

BACKGROUND & OBJECTIVE: The prolongation of life expectancy results in an increasing number of aged patients with hypopharyngeal carcinoma who have poor surgical tolerance because of degenerative organ functions. This study was to explore the surgical methods and preservation of laryngeal function for aged patients with hypopharyngeal carcinoma. METHODS: Clinical data of 84 patients with hypopharyngeal carcinoma who aged above 60 years, treated from 1996 to 2001, were retrospectively reviewed. Of the 84 cases, 68 were originated from pyriform sinus, 5 from postcricoid area, 11 from posterior pharyngeal wall; 57 patients received partial laryngectomy with laryngeal function preservation, 27 received total laryngectomy. Kaplan-Meier method and log-rank test were used to evaluate the survival rates. RESULTS: The overall 3- and 5-year survival rates were 60.7% and 53.3%, respectively. The 3- and 5-year survival rates of laryngeal function preservation group was not significantly different from those of total laryngectomy group (63.2% vs. 55.6%, P = 0.37; 56.7% vs. 46.3%, P > 0.05). In laryngeal function preservation group, 39 (68.4%) had all functions preserved (voice, respiration, and deglutition), and 18 (31.6%) partially preserved (voice and deglutition). CONCLUSION: It is safe and effective to treat aged hypopharyngeal carcinoma patients with surgery, and is possible to preserve laryngeal function in T3-4 stage aged patients who have no involvement of contralateral larynx, no invasion to esophagus, and no deglutition difficulty.

[The expression and significance of bcl-2 and bax in each phase of the cell cycle in laryngeal carcinoma].

OBJECTIVE: To detect the expression of bcl-2 and bax in each phase of cell cycle in laryngeal carcinoma, and explore the relationship between the expression of bcl-2 and bax in each phase of the cell cycle and the occurrence, development and prognosis in the carcinoma of larynx. METHODS: The immunohistochemical method, TUNEL technique and flowcytometry (FCM) parameter analyses were combined to detect the apoptosis and the expression of bcl-2 and bax in each phase of the cell cycle in 15 polyps of vocal cord and 387 laryngeal carcinomas. RESULTS: Total bcl-2 expression and bcl-2 expression in G0G1 stage in laryngeal carcinoma was significantly higher than that in polyp of vocal cord. In contrast, the total bax expression and the bax expression in each phase of cell cycle in laryngeal carcinoma were all lower than that in polyp of vocal cord. The total apoptosis index in laryngeal carcinoma was obviously lower than that in polyp of vocal cord, and this phenomenon was mainly caused by the decrease of the apoptosis in G0G1 phase. The bcl-2, bax expression and the apoptosis wasn't notably related to clinical stage, clinical type and T grade. In poor-differentiated squamous carcinoma, the bcl-2 expression in S and G2M phase was obviously higher than that in well-differentiated and the moderate-differentiated squamous carcinoma. The total apoptosis index, the apoptosis in S phase and the apoptosis in G2M phase were obviously enhanced both in the group of recurrence and in the patients who died in 5 years after the operation, in the same samples, the significant increasing of bcl-2 expression in S and G2M phase was detected. CONCLUSIONS: The significant decreasing of the apoptosis in G0G1 phase caused by high expression of bcl-2 was an important affair in the initial stage of laryngeal carcinoma. Accompanying the significant increasing of the total apoptosis index, the apoptosis in S phase and the apoptosis in G2M phase could be regard as an indicator that the cancer of larynx was malignant with poor prognosis and need adjuvant therapy. The decreasing of bax expression may play a role in the occurrence of laryngeal carcinoma.

[Substitution of esophagus with stomach or colon without thoracotomy in the treatment of cervical esophageal carcinoma with laryngeal function preserved].

OBJECTIVE: To study the feasibility and effect of substituting esophagus with stomach or colon without thoracotomy in the treatment of cervical esophageal carcinoma with laryngeal function preserved. METHODS: Twenty-four patients with cervical esophageal carcinoma were retrospectively reviewed. The esophagus was resected and substituted with 19 gastric pull-up and 5 colon interposition. Nineteen patients received radiotherapy postoperatively (dose 50 - 70 Gy). RESULTS: Twenty two patients were follow up over 3 years. The 3- and 5-year survival rates for T2 were 3 and 1, for T3, T4 8 and 3, respectively. The laryngeal function preservation rate was 77% (17/24) and the decannulation rate was 75% (12/16). The complication rate was 29%. CONCLUSION: Surgical resection of cervical esophageal carcinoma with removal of the extraesophageal invaded tissues while preserving the laryngeal function is possible. The continuity of the esophagus is restored by stomach transposition and colon interposition. Combined with radiotherapy, the survival rate and life quality of the patient might be improved.

[Reconstructing or pulling down tongue-base in surgical treatment of laryngeal cancer].

BACKGROUND & OBJECTIVE: The surgical treatment of laryngeal cancer, especially for the supraglottic cancer, usually involve the management of tongue-base, which is important in the rebuilding laryngeal function. There was no simple and effective method to repair tongue-base previously, which was removed for the greater part when invaded by advanced laryngeal cancer. As a result, many cases could not regain the satisfactory laryngeal function. And only several published reports focused on the efficacy of rebuilding laryngeal function by means of tongue-base flap. In order to develop a simple and reliable method to rebuild the laryngeal function, the management of tongue base in surgical treatment of laryngeal cancer was explored. METHODS: After the laryngeal carcinoma or the involved tongue-base was removed, according to the extent of surgical defect, sternohyoid myofascial flap was used to reconstruct the tongue-base, or the tongue-base was selected to rebuild the laryngeal function when greater part of it was preserved. RESULTS: Out of the 32 cases with partial laryngectomy, 26 cases were decannulated with a decannulation rate of 81.3%, all the cases regained speaking functions except 4 cases undergone total laryngectomy. All the cases resumed normal diet, none presented complication of accidental aspiration. The 3-year and 5-year survival rates were 81.3% and 65.6%, respectively. CONCLUSION: Reconstructing or pulling down the tongue-base is highly effective in rebuilding satisfactory laryngeal function, which is easily and simply performed with less damage and complications, appropriate for surgical treatment of laryngeal cancer.

[Surgical treatment of tonsillar cancer].

OBJECTIVE: To study the surgical treatment of tonsillar cancer. METHODS: Twenty-four patients with tonsillar cancer were treated with surgery and postoperative radiotherapy. The choice of surgical procedure was decided on the condition of the lesion. The tumor was resected through the transoral approach, mandibular swing approach, mandibular resection approach or hyoid approach. Surgical defect was repaired by pectoralis major myocutaneous flap, sternohyoid myofascial flap, tongue flap or soft palate flap. RESULTS: The 3- and 5-year survival rates were 76.0% and 60.8%. Function of chewing, deglutition, respiration and speech was restored well. CONCLUSION: Method of total resection of the tonsillar carcinoma through the optimum approach is best chosen according to the condition of the lesion, while preserving the oropharyngeal function. When combined with postoperative radiotherapy, the survival rate and quality of life of patients can be improved.

[Surgical management of benign pharyngo-esophageal stenosis].

OBJECTIVE: To study the methods and outcome of surgical management for pharyngo-esophageal stenosis. METHODS: Twenty-seven patients with pharyngo-esophageal stenosis from January 1983 to June 2001 were reviewed. Among 27 cases, there were 12 cases accompanied with laryngeal stenosis and one case accompanied with tracheal stenosis. In terms of etiological factor, all patients were cataloged into two groups, i.e. 25 cases with chemo-causis and 2 cases with trauma. The repair methods included colon interposition in 20 patients, free jejunum transplantation in 6 patients and pectoralis major muculocutaneous flap in 1 patient. In total 12 cases of laryngeal stenosis, sternohyoid myofascial flap was applied in 8 cases, and sternohyoid myofascial flap and epiglottis were applied in 4 cases. RESULTS: Swallow function recovered in 25 cases and failed in 2 cases. Laryngeal function recovered totally in 10 patients and partially in 2 patients with laryngeal stenosis. The patient with tracheal stenosis recovered and decannulated. CONCLUSION: According to the foci of pharyngo-esophageal stenosis, the colon interposition, the free jejunum transplantation and the pectoralis major myocutaneous flap can be applied respectively to restore normal physiological function.

[Surgical management of primary cervical tracheal cancer].

OBJECTIVE: To review the experience of surgical treatment of primary cervical tracheal cancer. METHODS: Six patients with primary cervical tracheal cancer were treated surgically from January 1997 to April 1999. The trachea anastomosis, platysmamyocutaneous flap combiend with the facial flap of the sternohyoid muscle, sternocleidomastoid myoperiosteal flap and the pectoralis major muculocutaneous flap were applied to restore the defects of cervical trachea. By pathology, there were two squamous cell carcinomas, three adenoid cystic carcinomas, and one adenocarcinoma. RESULTS: Six cases were decannulated from 23 days to 3 months after operation. The length of follow-up was more than 3 years. Five cases have stable airway by fiberscope and good voice after decannulation and there is no recurrence. One case died of lung metastasis 2 years after operation. CONCLUSION: Trachea anastomosis is suited for small partial defect. The platysmamyocutaneous flap combined with the facial flap of the sternohyoid muscle, sternocleidomastoid myoperiosteal flap and the pectoralis major muculocutaneous flap are ideal transplant for cervical tracheal reconstruction.