gms | German Medical Science

Introduction: We present a 48 years old male patient who has been undergone a laryngectomy with both side neck dissection and an implantation of voice prosthesis and additional radio-chemotherapy because of subglottic tracheal carcinoma pT4 pN2c cM0 from 09 to 11/2008. After one year he presented with swallowing and speaking problems.

Methods/procedure: By rigid esophagoscopy it was not possible to pass the upper sphincter because of a tumor mass approx. 15 cm aboral from which a biopsy was taken. X-ray examination of the esophagus, computed tomography of the neck and histology revealed a recurrent carcinoma. It was staged as rcT3 cN0 cM0. The case was discussed in our tumor board together with neuroradiologists, oncologists, radio-oncologists and visceral surgeons. After consideration all options salvage surgery was decided including both side neck dissection, resection of the whole pharynx and upper esophagus and defect reconstruction with a jejunum interponat. A voice prosthesis was also placed.

Results: After salvage surgical procedure the patient recovered rapidly without complications. Swallowing and speaking was possible as well as before. Histological examination showed complete resection, i.e. with a margin of healthy tissue all round, but a metastasis with lymphangiosis in the left thyroid gland. Thus, re-staging was rpT3 pN0 pM1 R0 L1 V0. Therefore the patient got two runs of palliative first line-chemotherapy with carboplatinum and taxotere, once a week for a total of thirteen weeks. Swallowing and speaking were still fine and no recurrence was seen up to now.

Conclusion: Recurrent, synchronous or metachronous carcinomas after primary curative treatment (surgery and/or radio-chemotherapy) are a therapeutic challenge. In those cases interdisciplinary salvage surgery and particulary the jejunum-interponat should always be considered.