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A survey of the clinical outcomes of cervical esophageal carcinoma surgery focusing on the presence or absence of laryngectomy using the National Clinical Database in Japan

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Abstract

Background

One upside of cervical esophageal carcinoma is that radical surgery can be performed by laryngectomy, even for tumors with tracheal invasion. However, this approach drastically reduces the quality of life, such as by losing the vocal function. Cervical esophageal carcinoma is rare, and no comprehensive reports have described the current state of surgery. Using a Japanese nationwide web-based database, we analyzed the surgical outcomes of cervical esophageal carcinoma to evaluate the impact of larynx-preserving surgery.

Methods

Based on the Japan National Clinical Database, 215 surgically treated cases of cervical esophageal carcinoma between January 1, 2018, and December 31, 2019, were enrolled. Clinical outcomes were compared between the larynx-preserved group and the laryngectomy group.

Results

Ninety-four (43.7%) patients underwent larynx-preserving surgery. A total of 177 (82.3%) patients underwent free jejunum reconstruction. More T4b patients and more patients who underwent preoperative radiotherapy were in the laryngectomy group. There were no significant differences in the frequency and the severity of morbidities between the two groups. However, in the laryngectomy group, in-hospital death within 30 days after surgery was observed in 1 patient, and the postoperative hospital stay was significantly longer (P = 0.030). In the larynx-preserved group, recurrent nerve paralysis was observed in 24.5%. Re-operation (35.3%, P = 0.016), re-intubation (17.6%, P = 0.019) and tracheal necrosis (17.6%, P = 0.028) were significantly more frequent in patients who underwent pharyngolaryngectomy with total esophagectomy and gastric tube reconstruction than in others.

Conclusion

Larynx-preserving surgery was therefore considered to be feasible because it was equivalent to laryngectomy regarding the short-term surgical outcomes.

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Acknowledgements

The authors sincerely thank all participants in the NCD project for their great efforts in data registration. We thank Shinya Hirakawa, PhD, for his efforts in data management as a sub-analyzer. We also thank Takeshi Naito, MD, PhD and Kinji Kamiya, MD, PhD, for giving appropriate advice as a supervisor, and we also thank the working members of the database committee in the Japanese Society of Gastroenterological Surgery and the Japan Esophageal Society. The authors wish to acknowledge Mr. Keita Shimoakasho, the Japanese Society of Gastroenterological Surgery and Ms. Hitomi Okamoto, Ms. Natsumi Yamamoto and Mr. Nariyoshi Butsuda, National Clinical Database, Japan, for their valuable assistance regarding administration and database information.

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Authors and Affiliations

  1. Department of Surgery, Edogawa Hospital, 2-24-18 Higashi-Koiwa, Edogawa-ku, Tokyo, 133-0052, Japan

    Yasuaki Nakajima

  2. Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan

    Hisateru Tachimori

  3. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hisateru Tachimori & Hiroaki Miyata

  4. Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan

    Yutaka Miyawaki, Hiroshi Sato & Shinichi Sakuramoto

  5. Department of Esophageal Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Naoto Fujiwara & Kenro Kawada

  6. Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan

    Hiroaki Miyata

  7. Department of Gastroenterological Surgery and Clinical Oncology, Graduate School of Medicine, Toho University, Tokyo, Japan

    Hideaki Shimada

  8. The Japan Esophageal Society, Tokyo, Japan

    Yasuaki Nakajima, Yutaka Miyawaki, Naoto Fujiwara, Kenro Kawada, Hiroshi Sato, Shinichi Sakuramoto, Hideaki Shimada & Yuichiro Doki

  9. Database Committee, The Japan Esophageal Society, Tokyo, Japan

    Masayuki Watanabe

  10. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yoshihiro Kakeji

  11. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan

    Yuko Kitagawa

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  1. Yasuaki Nakajima
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  2. Hisateru Tachimori
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  8. Shinichi Sakuramoto
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  9. Hideaki Shimada
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  13. Yuko Kitagawa
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Corresponding author

Correspondence to Yasuaki Nakajima.

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Ethical Statement

The study protocol was approved by the Japan Esophageal Society, the Japanese Society of Gastroenterological Surgery, and the Institutional Review Board of Edogawa Hospital (Approval Number 2020–19).

Conflict of interest

Author HM are affiliated of a social collaboration department supported by Grants from National Clinical Database, Johnson & Johnson KK, and Nipro Co. Author YK are supported by grants from Takeda Pharmaceutical Co., Ltd., CHUGAI PHARMACEUTICAL CO., LTD., TAIHO PHARMACEUTICAL CO., LTD, Yakult Honsha Co. Ltd., ASAHI KASEI PHARMA CORPORATION, Otsuka Pharmaceutical Co., Ltd., ONO PHARMACEUTICAL CO., LTD., TSUMURA & CO., Kyouwa Hakkou Kirin Co., Ltd., DAINIPPON SUMITOMO PHARMA Co., Ltd., EA Pharma Co., Ltd., Astellas Pharma Inc., Toyama Chemical Co., Ltd, MEDICON INC., KAKEN PHARMACEUTICAL CO. LTD., Eisai Co., Ltd., Otsuka Pharmaceutical Factory Inc., TEIJIN PHARMA LIMITED., NIHON PHARMACEUTICAL CO., LTD. and Nippon Covidien Inc.. Author YK also received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from CHUGAI PHARMACEUTICAL CO., LTD., TAIHO PHARMACEUTICAL CO., LTD, ASAHI KASEI PHARMA CORPORATION, Otsuka Pharmaceutical Factory Inc., SHIONOGI & CO., LTD., Nippon Covidien Inc., Ethicon, Inc., ONO PHARMACEUTICAL CO., LTD., Olympus Corporation, Bristol-Myers Squibb KK, AstraZeneca KK, MSD KK, Smith & Nephew KK and KAKEN PHARMACEUTICAL CO., LTD.. Other authors declare that they have no conflict of interest.

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Nakajima, Y., Tachimori, H., Miyawaki, Y. et al. A survey of the clinical outcomes of cervical esophageal carcinoma surgery focusing on the presence or absence of laryngectomy using the National Clinical Database in Japan. Esophagus 19, 569–575 (2022). https://doi.org/10.1007/s10388-022-00944-3

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  • DOI: https://doi.org/10.1007/s10388-022-00944-3

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