Value of postoperative radiation therapy for regional control after dissection in head and neck squamous cell carcinoma cases.

OBJECTIVE: We aimed to define clinicopathologic risk factors associated with regional recurrence (RR) and thus the effectiveness of postoperative radiotherapy (PORT) for neck control for head and neck squamous cell carcinomas (HNSCCs) with differing cervical lymph node status. METHODS: A retrospective study was performed in 196 HNSCC patients with pathologically positive neck node (N+) to evaluate the high-risk factors for RR and to define the role of PORT in control after neck dissection and postoperative radiotherapy (PORT). RESULTS: Overall, the RR rate after neck dissection and PORT was 29%. Extracapsular spread (ECS) was confirmed to be the only independent risk factor for RR. There were no significant risk factors associated with RR in the ECS- group. The 5-year disease-specific survival rate was 45%, which descended to 10% with the emergence of RR. CONCLUSIONS: ECS remains a determined risk factor for RR after neck dissection and PORT in patients with N+. PORT alone is not adequate for preventing RR in the neck with ECS after neck dissection. More intensive postoperative adjuvant therapies, especially combined chemotherapy and radiotherapy, are needed to prevent regional failure in HNSCC patients with ECS.

[Recurrence and surgical salvage of sinonasal squamous cell carcinoma].

OBJECTIVE: To analyze the significant clinicopathologic factors related to tumor recurrence in patients with sinonasal squamous cell carcinomas (SCC) and to evaluate the effectiveness and plausibility of surgical salvage in the recurrent cases. METHODS: The clinicopatholgic data of 107 patients with primary sinonasal SCC treated from 1996 to 2007 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were used to define the risk factors related to tumor recurrence. Salvage surgery with was selectively carried out in the recurrent sinonasal SCC using different surgical approaches, including lateral rhinotomy midfacial degloving or combined craniofacial approach. Immediate reconstruction of major surgical defects were performed with latissimus dorsi flap, pectoralis major myocutanneous flap, temperalis fasciomuscular flap, free rectus abdominis flap and free radial forearm flap. All patients were routinely follwed up and 5-year survival were calculated using directly calculating method and Kaplan-Meier's method. RESULTS: The 5-year survival rate of 107 cases was 52.3% (56/107). Local recurrence was the most common pattern of tumor relapse. Forty-four of the 107 cases had recurrence. Logistic regression analysis showed the T stag was the most important impacting factor for tumor recurrence (OR = 0.258, P = 0.001). Of 44 cases with recurrence, 33 cases underwent salvage surgery and the 5-year survival rate after salvage surgery was 29.1%. CONCLUSIONS: T stag is the most important impacting factor for tumor recurrence. Salvage surgery with immediate reconstruction of major surgical defects should be carried out in the selective cases of recurrent sinonasal SCC.

[Outcomes of salvage laryngectomy after initial radiation failure in laryngeal squamous cell carcinoma].

OBJECTIVE: To investigate survival outcomes of salvage surgery preformed for laryngeal squamous cell carcinoma that recurred or progressed after radiotherapy alone. METHODS: A review of 72 patients who underwent salvage laryngectomy for laryngeal cancer failed in initial radiation therapy between 1996 and 2005 was performed. The tumor persistence occurred in 50 cases and recurrence in 22 cases. All patients received salvage total laryngectomy and radical neck dissection. Survival analysis was performed by using Kaplan-Meier method, Log-rank test and Cox proportional hazard model. RESULTS: Thirty patients developed a postoperative complication after salvage surgery. Pharyngocutaneous fistula occurred in 15(20.8%) patients. During 5 years after salvage surgery, the rates of tumor recurrence, distant metastasis and second malignancy were 34.7%, 22.2% and 6.9%, respectively. Kaplan-Meier analysis showed that overall 3 year and 5 year survival rates of those patients after operation were 45.8% and 36.1%, respectively. Univariate analysis indicated that N restage, tumor persistence/recurrences after radiotherapy, surgical margin status, level of tumor invasion, pathologic N stage, extracapsular nodal spread and invasion of nonlymphotic structures were significantly associated with overall survival. Multivariate analysis showed the most significant prognostic factors were tumor persistence or recurrence after radiotherapy, surgical margin status and level of tumor invasion. CONCLUSIONS: Surgical salvage remains the gold standard for management after failure of initial radiation therapy. The extent of tumor invasion must be assessed sufficiently before operation, and the surgical margin status must be identified in operation by using a frozen sectioning approach, especially in patients with tumor invasion to muscle/cartilage and tumor persistence after radiotherapy.

[Clinicopathologic aspects of locoregional recurrence of hypopharyngeal cancer and their implication on the survival of patients].

OBJECTIVE: To investigate the clinicopathologic aspects of locoregional recurrence and their implication on the survival in patients with hypopharyngeal cancer. METHODS: A retrospective review of 101 patients with hypopharyngeal cancer that were treated with surgical management and postoperative radiotherapy from 1998 to 2004 was performed. The clinicopathologic risk factors for locoregional recurrence were evaluated by using univariate chi(2) tests and multiple stepwise Logistic regression models. Survival analysis was performed by using Kaplan-Meier method, Log-Rank test and Cox proportional hazard model. RESULTS: The overall incidence of locoregional recurrence in this series of hypopharyngeal cancer was 43.6% (44/101). The rates of recurrence were local 13.9% (14/101), regional 31.7% (32/101). In a multivariate Logistic regression analysis, it was confirmed that number of levels with pathologic lymph node (OR = 0.334, P = 0.0242) was the most significant risk factors for locoregional recurrence. The same for regional recurrence was capsule rupture of pathologic lymph node (OR = 0.353, P = 0.0389) and multilevel positive nodal involvement in neck (OR = 0.259, P = 0.0069). The overall survival of hypopharyngeal cancer was 23.2%, and reduced to 11.4% for locoregional recurrence. The recurrences were managed by salvage surgery in 12 cases, which included local recurrences after partial pharyngolaryngectomy, ipsilateral regional recurrences after selective neck dissection, and contralateral regional recurrences at initially uninvolved neck. The overall survival of those patients sustained 33.3%. A multivariate Cox regression analysis revealed that the factors impacting the prognosis were recurrent time (RR = 0.317, P < 0.0001) and treatment modality after locoregional recurrence (RR = 6.119, P = 0.0001). CONCLUSIONS: Locoregional recurrences are frequent and have a very negative impact on patient survival in hypopharyngeal cancer, which most commonly have a regional recurrence. Salvage surgery in suitable cases seems to improve survival rates. Much attention should be paid to cervical pathological factors for locoregional recurrences in hypopharyngeal cancer, especially multilevel and capsule rupture of pathologic lymph node.

[Investigations on salvage surgery-related problems for stomal recurrence after total laryngectomy].

OBJECTIVE: To explore the related issues concerning salvage surgery for stomal recurrence (SR) after total laryngectomy. METHODS: A retrospective study was conducted to analyse the clinical data from 36 patients suffering from SR after total laryngectomy, who were treated by salvage surgery from January 1990 to January 2006. Some related issues concerning salvage surgery for SR were studied and analysed, which include preoperative evaluations, surgical approaches and techniques, management of perioperative complications and outcomes of treatment. RESULTS: After careful preoperative evaluations and predictions, a complete resection of tumor was achieved in 33 out of 36 SR patients. Two patients sacrificed because of ruptures of major vessels including the common carotid eaters and the innominate artery 3 weeks and 2 months after the operation. The overall 1-year, 2-year and 3-year survival of this group of patients were 68.8%, 42.8% and 12.5%, respectively. Besides, postoperative complications comprise 23 cases of hypothyroidisms, 6 cases of wound infection and saliva leakage, 8 cases of donor site complications (including dehiscence of wound in 3 cases, chest wall hematomas in 4 cases, and tumor seeding in 1 case), and hypopharyngeal stenosis in 4 cases, all of which were properly and promptly managed with uneventful outcomes. CONCLUSIONS: SR after total laryngectomy is a dangerous and complicated status with poor prognosis. For the purpose of saving or elongating the patients's lives, the salvage surgery needs to be done on the condition that indicated candidates are properly selected, preoperative evaluations carefully conducted, and perioperative abnormal conditions unerroneously delt with.

[Multi-modalities for reconstruction of circumferential defects in the pharyngoesophageal region].

OBJECTIVE: To investigate the feasibility of multi-modalities in the reconstruction of circumferential defects after resection of cancers in pharyngoesophageal regions, and to compare the pros and cons between different surgical procedures. METHODS: According to the nature and extend of defects, five different methods including pectoralis major myocutaneous flap, laryngeal tube replacement, free jejunum, free forearm flap and gastric pull-up were used to reconstruct the circumferential pharyngoesophageal defects in 72 patients. Function of deglutition and restoration of swallowing was regularly followed up and objectively evaluated. RESULTS: A total of 35 cases of pectoralis major myocutaneous (PM) flaps, 8 cases of laryngeal tube replacement, 12 cases of free jejunum, 12 cases of free forearm flaps and 16 cases of gastric pull-up were performed. Different complications including wound infection, pharyngeal fistula, partial necrosis of PM flap, partial necrosis of gastric wall, stricture of anastomotic site were encountered in 15 cases. All patients survived the operation except one due to partial necrosis of the gastric wall. Two of 4 patients who developed anastomotic stricture can ingest half-liquid food, the remaining cases regained normal deglutition function. The mean postoperative follow-up time was 1. 6 years with 2-year survival rate of 45.3%. CONCLUSIONS: Circumferential defects resulting from resection of carcinomas in pharyngoesophageal region can be reconstructed with different operative techniques depending on the nature and extend of the defects. Once the operative indications are properly selected, the good reconstructive results are to be achieved.

[Clinicopathologic features and prognostic factors of cervical lymph node metastasis in oral squamous cell carcinoma].

BACKGROUND & OBJECTIVE: The cervical lymphatic meta-static rate of oral squamous carcinoma is 50%-59%. The management of cervical lymphatic metastasis relates with prognosis of patients with oral squamous carcinoma. This study was to investigate the clinicopathologic features and prognosis factors of cervical lymph node metastasis in oral squamous cell carcinoma. METHODS: Clinicopathologic data of 191 patients with oral squamous cell carcinoma were retrospectively reviewed. The relationship between histopathologic factors and cervical lymph node metastasis was evaluated by univariate Chi(2) test. Cox regression model was used to analyze impacts of pathologic factors of cervical lymph nodes, such as metastatic status, size and number of positive neck nodes,levels of positive nodes, the lowest involved nodal level, on prognosis. RESULTS: The overall 5-year survival rate of the 191 patients was 48.7%. Univariate Chi(2) test confirmed that only depth of primary tumor infiltration correlated to cervical lymph node metastasis. Cox regression analysis revealed that clinical N stage, cervical lymphatic metastatic status, number of involved levels, and the lowest involved nodal level affected prognosis of patients, the most significant prognostic factors of cervical lymph node were clinical N stage, and the lowest involved nodal level. CONCLUSIONS: Cervical lymph node metastasis is a significant prognostic factor of oral squamous cell carcinoma. The identification of metastatic patterns of cervical lymph nodes, and the management targeting pathologic factors of cervical lymph node affecting survival are critical for improving the treatment effect on oral squamous cell carcinoma.

[The feathers of Wegener granulomatosis in otorhinolaryngology].

OBJECTIVE: In order to study the characteristic of Wegener granulomatosis in otorhinolaryngology. METHOD: We investigated and treated 6 patients. RESULT: Five cases were remission, 1 case died. CONCLUSION: The feathers of Wegener granulomatosis in otorhinolaryngology have nothing in common with each other, the characteristic of clinic is complicate, cyclophosphamide deltasone and co-trimoxazole are effective.

[Clinical analysis of 71 cases of multiple primary cancers in head and neck squamous carcinomas].

OBJECTIVE: To study the location, treatment, life status of multiple primary cancers (MPCs) in head and neck squamous cell carcinomas. METHODS: The clinical data of 71 head and neck squamous carcinoma patients with MPCs were retrospectively analyzed. RESULTS: MPCs were seen in head and neck regions in 27 cases and in remote organs in 42 cases, two of which were triplicate primary cancers. Four cases were synchronous MPCs, including one patient with synchronous triplicate primary cancer. Other 67 cases were heterochronous MPCs, including one patient with heterochronous triplicate primary cancer. Of 67 heterochronous MPCs, the time interval between index tumor presentation and diagnosis of MPCs was eight months to twelve years. MPCs occurred in seventy percent index oral cavity squamous cancers, which were located in head and neck regions, and in sixty-two percent index hypopharynx cancers and seventy-nine percent index laryngeal cancers, which were located in remote organs. The incidence of MPCs in esophagus and lung was higher than that in other remote organs. Among the various MPCs in this serials, the incidence of the disease appeared to be the highest in esophagus, accounting for twenty-four percent of all cases. The total three- and five-year survival rates were 32.4% and 22.5%, respectively. Of all MPCs patients, the three-year survival rate for patients who received different therapies for their MPCs was obviously higher than that of untreated patients (P < 0.01, Chi-square test). CONCLUSIONS: Esophageal carcinoma is the most common second primary cancer among the various MPCs of the head and neck squamous carcinomas. Oral cavity cancers tend to have more MPCs in the head and neck regions, and laryngeal and hypopharyngeal cancers are easily to be associated with MPCs in the remote organs. Regular follow-up and early diagnosis with effective treatment can help to improve the survival of MPC patients in head and neck squamous cell carcinomas.

[Analysis of risk factors in the prediction of distant metastases of head and neck squamous cell carcinomas].

OBJECTIVE: To investigate the risk factors related with distant metastases (DM) from head and neck squamous cell carcinomas (HNSCC). METHODS: A retrospective study was carried out to review the histopathological data from 532 HNSCC patients treated in Bethune International Peace Hospital from February 1978 to February 1998. The incidence and the risk factor for DM were evaluated in a model that included the following factors: sex, age, clinical staging, T and N staging, site of primary tumor, depth of primary tumor infiltration, histological grade of primary tumor, presence of cervical lymph node metastasis, number of positive neck nodes and levels involved, and presence of extracapsular nodal spread. Univariate chi2 test and multivariate stepwise logistic regression model were used for the analysis. Statistical analysis of overall survival was performed using Kaplan-Meier method. RESULTS: Sixty cases (11.3%) presented distant metastases in 532 patients of head and neck squamous cell carcinomas. In a univariate analysis, it was confirmed that the following variables correlated to DM, i.e., clinical staging (P = 0.0126), T classification (P = 0.0082), site of primary tumor (P = 0.0011), depth of primary tumor infiltration (P = 0.0005) , presence of cervical metastasis (P = 0.0057), number of positive neck nodes (P = 0.0149) and levels involved (P = 0.0034), presence of extracapsular nodal spread (P = 0.0118). In a multivariate analysis, the most significant risk factors for DM were the site of primary tumor and the depth of primary tumor infiltration. Kaplan-Meier analysis showed that overall survival rates of 60 HNSCC patients who presented distant metastases were 51.7% at 1 year, 13.3% at 3 years, 6.5% at 5 years, respectively. CONCLUSION: The site of primary tumor and the depth of primary tumor infiltration are the key risk factors in determining the development of DM in HNSCC patients. Patients with laryngeal and hypopharyngeal carcinomas and patients with primary tumor infiltrating muscular, bone or cartilage level have the highest risk of developing DM.

[Phonation assessment of voice restoration after laryngectomy].

OBJECTIVE: To take an objective phonation assessment for the patients who have taken the tracheo-esophageal (TE) shunt procedure after total laryngectomy. METHOD: Twenty-four patients after TE shunt procedure were selected as TE group. Esophageal speakers after total laryngectomy and normal subjects were considered as controls. All the subjects of three groups took part in the voice acoustic assessment and MPT measurement. Twenty TE speakers took part in intra-tracheal pressure measurement. TE speakers and esophageal speakers participated in the electronic laryngoscope examination. RESULT: There were no significant differences between TE group and esophageal group in every acoustic parameters, but there were very remarkable differences between TE group and normal subjects in jitter, shimmer, harmonics to noise ratio and normalized noise energy. The pressure of TE speakers for comfortable /a/ is (2.86 +/- 0.69) kPa. The pharyno-esophageal segment vibrated regularly in most alaryngeal speakers and shapes of neo-glottis of most alaryngeal speakers were circular. CONCLUSION: Acoustic parameters of TE speakers were similar to those of esophageal speakers, but the tone of TE speakers was more similar to the normal controls. Speaking of the patients after the TE shunt procedure is laborsaving.

[Clinical pathology feature and prognostic factors of cervical lymph node metastases in hypopharyngeal carcinoma].

OBJECTIVE: To investigate the risk clinicopathological factors of primary tumor in the prediction of cervical lymph node metastases and the cervical lymph node prognostic factors in hypopharyngeal squamous cell carcinoma. METHODS: A retrospective study was carried out to review the histopathological data from 98 hypopharyngeal squamous cell carcinoma patients. The relationship between histopathological parameters and cervical lymph node metastases were evaluated by means of a univariate chi2 test and multivariate stepwise logistic regression model. And the Cox regression model was used to define possible pathological parameters of neck node affecting survival including N staging, presence of cervical lymph node metastases and extracapsular nodal spread, size and number of positive neck nodes, and levels of positive neck nodes. RESULTS: The overall 5-year survival rate of patients with hypopharyngeal carcinoma was 28.6%. In a univariate and multivariate analysis, it was confirmed that size and growth pattern of primary tumor correlated to cervical lymph node metastases. In a multivariate Cox regression analysis, the most significant prognostic factors of cervical lymph node were the size of positive neck nodes and level involved. CONCLUSIONS: Cervical lymph node metastases were one of the most significant prognostic factors of hypopharyngeal carcinoma. The identification of patients at risk for cervical lymph node metastases and the management of the neck by coping with pathological factors of cervical lymph node affecting survival are very important to improve the treatment and prognosis of hypopharyngeal carcinoma.

[Patterns and prognostic factors of cervical lymph node metastasis in supraglottic laryngeal carcinoma].

OBJECTIVE: To investigate the risk factors in the prediction of cervical lymph node metastases and the cervical lymph node prognostic factors in supraglottic laryngeal carcinoma. METHOD: A retrospective study was carried out to review the histopathological data from 55 supraglottic laryngeal carcinoma patients. The relationship between histopathological parameters and cervical lymph node metastases were evaluated by means of a univariate chi2 test and multivariate stepwise logistic regression model. And the Cox regression model was used to define possible pathological parameters of cervical lymph node affecting survival including N staging, presence of cervical lymph node metastases and extracapsular nodal spread, size and number of positive neck nodes, and levels of positive neck nodes. RESULT: In a univariate analysis, it was confirmed that the following variables correlated to cervical lymph node metastases, i.e., depth of primary tumor infiltration, size and histological grade of primary tumor. In a multivariate analysis, the most significant risk factors for cervical lymph node metastases were the size and histological grade of primary tumor. The overall 5-year survival rate of patients with supraglottic laryngeal carcinoma was 52.7%. In a Cox regression analysis, N staging, size of positive neck nodes, presence of cervical lymph node metastasis and extracapsular nodal spread were found to be related to the prognosis of supraglottic laryngeal carcinoma. CONCLUSION: Cervical lymph node metastasis is one of the most significant prognostic factors of supraglottic laryngeal carcinoma. The identification of patients at risk for cervical lymph node metastasis and the management of the neck by coping with pathological factors of neck node affecting survival are crucial steps to improve the effect of supraglottic laryngeal carcinoma treatment.

[Superior mediastinum exposure in the removal of the advanced cancers in the lower neck regions].

OBJECTIVE: In order to achieve the radical removal of advanced cancers involving the lower neck regions. METHODS: Upon the thorough evaluation of tumors with different imaging methods, several kinds of superior mediastinum exposure were carried out in a series of 18 patients with advanced neck cancer of various kinds. There were 10 cases of stomal recurrence, 2 cases of recurrent thyroid carcinomas, 2 cases of advanced carcinomas in the cervical trachea, and 4 cases of metastatic carcinomas in the supraclavicular region. According to the site and extension of tumor invasion, simple manubrium resection were performed in 10 cases, resection of the medial half of the clavicle was adopted in 4 cases and resection of the manubrium and the medial 1/3 of both clavicles were used in 4 cases. Pectoralis major myocutaneous flaps were raised to reconstruct the defects resulting from tumor ablations. RESULTS: Radical removal of tumors was achieved in 16 cases. Minor complications occurred in 3 cases including one case of intraoperative pneumothorax and 2 cases of postoperative pharyngeal fistula. One patient developed aneurysm in the right common carotid artery after radical neck dissection and wound infection. One patient died of eruption of the innominate artery due to the major vessel injury caused by the tracheostomy tube two months after the operation. Results from postoperative follow-up demonstrated that one-year, two-year and three-year postoperative survival rate was 72.2% (13/18), 22.2% (4/18) and 11.1% (2/18), respectively, in this series. CONCLUSION: Superior mediastinum exposure is a necessary and reliable surgical approach in the removal of advanced tumors involving the lower neck and superior mediastinum.

[A long-term observation of 48 cases of tracheoesophageal shunt phonation by the anastomosis of the membranous portion of the tracheal section with the anterior wall of esophagus after total laryngectomy].

OBJECTIVE: To study the long-term efficacy of tracheoesophageal (TE) shunt phonation by the anastomosis of the membranous portion of the tracheal section with the anterior wall of esophagus after total laryngectomy. METHODS: A questionnaire was designed to follow 48 patients with rehabilitated speech and swallow functions by the above approach. The qualities of phonation and speech, and the degree of aspiration evaluated, together with the survival rate and complications statistically analyzed. RESULTS: The speech level of 35 laryngectomees was similar to the normal laryngeal speech level. Thirty-five cases had longer maximal phonation time and hearing distance and higher speech intelligibility. Other 5 laryngectomees had less effective phonation, but higher speech intelligibility. The total effective rate was 83.3% (40/48). The speech fluency in 40 laryngectomees was not as good as that in the normal people. Forty percent laryngectomees(16/40) had slight liquid food aspiration which did not influence normal eating. Eight patients(8/48) failed to speak and no liquid aspiration occurred after the operation. The effective rate was affected obviously by neck infection and pharyngeal fistula formation. The survival rate was similar to those with single total laryngectomy. CONCLUSIONS: The TE shunt phonation had the advantages of simple, one-stage operation and high success rate. Some laryngectomees had slight liquid food aspiration, but would not influence normal eating. So this TE shunt phonation operation may be useful during laryngeal surgery.

[Observation of aspiration of laryngectomees in TE shunt speech without prosthesis].

OBJECTIVE: To investigate the course of variation and influencing factors on aspiration in laryngectomees who underwent tracheoesophageal (TE) shunt speech without prosthesis. METHOD: Sixteen laryngeal cancer patients who were operated on for TE shunt voice rehabilitation without prosthesis after total laryngectomy. These laryngectomees experienced aspiration in different degrees after the operation. We designed a questionnaire to follow up alteration aspiration. RESULT: Of sixteen laryngectomees, the longest follow-up time was nine years and six months, the shortest time was one year and three months, no one got lost in the follow-up. In the follow-up period, three laryngectomees died, other thirteen still survived. There were three basic aspiration variational courese: Seven patients changed from no leakage to slight leakage. Four patients remained slight leakage. Five patients changed from obvious leakage to slight leakage. Aspiration affect TE shunt speech in four different ways: No leakage, good voice; slight leakage, still good voice. No leakage,hard voice. If speak, take more time and use great effort. However,in some patients, if the slight leakage gradually appeared, the voice seemed to be better. If the slight leakage remained in the same degree,the patient got good voice all the time. Obvious leakage, hard voice. When leakage gradually became slight, voice grew better. There were no laryngectomees had the following situations: obvious leakage all the time, bad voice all the time. It was considered that radiation therapy induced aspiration in six laryngectomees. Neck infection and pharyngeal leak were believed to cause aspiration in five laryngectomees. CONCLUSION: Any surgical procedures with good voice, but no postoperative aspiration is the best choice in voice rehabilitation in laryngectomees. However, if some laryngectomees only have slight liquid food aspiration without interference with their normal diet; at the same time, those laryngectomees have high speech level,we consider the operation is acceptable. Definitely, radiation therapy, neck infection and (or) pharyngeal leak have some influence on aspiration. The variational course of aspiration and phonation change affected by aspiration are complex problems which need further investigation.

[Long-term results of one stage tracheoesophageal end-side anastomosis voice restoration after total laryngectomy].

OBJECTIVE: The purpose of this study is to discuss long-term results of one different kind of voice restoration after total laryngectomy with 10 years experience. METHOD: One stage tracheoesophageal end-side anastomosis after total laryngectomy was performed in 36 patients from 1991-1996. The key technique of this operation is to make a tongue-ship flap(1.5 cm x 1.5 cm-1.8 cm x 1.5 cm) with tracheal membranous part and dissect it from the esophagus to 1 cm below the upper incisal margin of trachea. Then a 0.8 cm middle vertical incision was made on the lowest anterior wall of the separated esophagus. Folding the tongue-ship flap posteriorly to approximate the esophagus incision and make an end-side anastomosis. Close the upper incisal margin of trachea with left to right direction suture. The follow up time is 5 - 10 year. One lost follow 2.5 years later and was judged as dead. RESULT: The short-term and long-term success rate were 69% (25/36) and 83% (30/36) respectively. The 3-, 5- and 10 year survival rate are 72%, 69%, 69%, respectively. CONCLUSION: This technique does not change the pattern of total laryngectomy and various neck dissections do not affect voice rehabilitation. Advantages of the operation: easy to operate and learn; the special form of tracheoesophageal shunt (high in the tracheal side and low in esophageal side) prevents the aspiration; high successful rate, excellent speech, fluent language, good acceptability and lower aspiration.