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Introduction: Cervical oesophagus represents a critical location for squamous cell carcinoma, which usually requires extensive surgery (pharyngo-laryngo-oesophagectomy). In the last decade, neoadjuvant chemo-radiotherapy was reported to be beneficial in the treatment of locally advanced squamous cell oesophageal cancer., Methods: Between November 1997 and January 2012, 55 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy, where the tumour was localized in the upper third. Patients received preoperative irradiation of 3960 cGy in 180 cGy fractions and simultaneously Cisplatin and 5-FU chemotherapy. Restaging was carried out after four weeks and patients considered operable were underwent surgery., Results: In patients with cervical oesophageal cancer 35 of 55 (64%) underwent oesophageal resection or pharyngo-laryngectomy. In 16 out of 35 resected specimens (46%) complete histopathological remission (pCR) was observed. Perioperative mortality and anastomotic leaks were the same: 5/35 (14%). R0 resection rate was 82% and the 2- and 5 years survival rates were 41% and 18%. In 19 cases a larynx preserving pharyngo-oesophagectomy was performed and a free jejunal graft was used for reconstruction after a pharyngo-laryngectomy in 11 cases., Conclusion: The high rate of pCR (46%) confirmed that upper third oesophageal cancer has superior sensitivity to multimodal treatment. In 30 cases neoadjuvant chemo-radiotherapy was able to achieve tumour regression and render pharyngo-laryngo-oesophagectomy unnecessary.

Introduction: Various plastic surgery techniques were applied for oesophageal reconstruction in complicated cases. Myocutaneous flaps that are suitable to cover soft tissue defects of the neck may also be transferred and used for partial defects of the cervical oesophagus or securing a vulnerable suture line. Application of microsurgical techniques may also be useful in certain situations., Patients and Methods: Pectoralis major myocutaneous flap was used in 5 cases in our department between 1998 and 2012. Microsurgical techniques were used in 38 cases of esophageal reconstruction, which were 34 free jejunal grafts and 4 supercharged colon grafts., Results: 23 patients underwent primary reconstruction after pharyngolaryngectomy, while 15 patients had secondary reconstruction after failed previous operations or recurrence. When more experienced was gained free jejunal grafts were used for the cervical as well as thoracic oesophagus. Three grafts were lost, two of them were due to anastomotic thrombosis and one was due to severe MRSA wound infection., Conclusion: Complicated cases of oesophagus reconstructions may be successfully treated by the cooperation of oesophagus and plastic surgeons, which may result in an acceptable complication rate.

The authors report the case of a colon adenocarcinoma developed on the neck at the anastomosis of the skin tube and colon 44 years following a corrosive oesophageal injury. This patient suffered a moderately severe oesophageal, stomach and laryngeal injuries due to drinking hydrochloric acid 44 years ago. He underwent serial laryngoplasties, then needed a tracheostomy, oesophagectomy, pyloroplasty and ileocolon transposition. An antethoracal oesophagus formation was performed with ileocolon and skin tube amendment. 44 years later an ulcerated adenocarcinoma developed in the transposed colon, which was resected and the ability to swallow was reinstated by the transplantation of an isolated jejunal segment using microvascular anastomosis.

Adenocarcinomas in Barrett's oesophagus are more commonly diagnosed at an early stage due to effective surveillance programmes. Subtotal oesophagectomy with extended lymphadenectomy is considered the best curative treatment for patients with early adenocarcinoma of the oesophagus. However, such treatment carries substantial morbidity and compromises quality of life. Limited resection, minimal invasive surgical procedures or endoscopic mucosal ablation have been proposed as less invasive alternatives. A comparison of treatment associated morbidity, recurrence rate, long-term survival and functional outcome suggests that none of these alternative methods can be universally recommended. An individualized strategy should be employed based on staging (tumour penetration into the mucosa/submucosa, presence of lymph node metastasis), multicentricity, length of the underlying Barrett mucosa and risk factors of the patient. Surgical resection (radical or limited) remains the treatment of choice for tumours invading the submucosa, or multicentric and recurrent tumours after endoscopic mucosectomy.

Introduction: The incidence of cicatricial carcinoma of the scarred esophagus in patients with corrosive injuries is relatively high. Therefore, the necessity to resect the diseased oesophagus was raised as opposed to carry out a simple by-pass reconstruction only., Case Report: A 56-year-old female patient with a past medical history of lye consumption presented with a stricture of the esophagus. She underwent resection of the diseased esophagus with mediastinal colon interposition. 28 years after surgery the patient had symptoms of progressive dysphagia and loss of weight caused by scar cancer of the esophagus. After neoadjuvant chemo-radiotherapy, resection of the remainder oesophagus was performed with free jejunal transplantation. On postoperative day 14 the patient had been discharged with no complications and good swallowing function., Conclusion: In our case, scar cancer developed 28 years after oesophageal resection and more than 50 years after the corrosive injury. This case is another argument for simple bypass.

Adenocarcinomas in Barrett's esophagus are increasingly diagnosed at early stages thanks to effective surveillance programs. Subtotal esophagectomy with extended lymphadenectomy is considered the best curative treatment for patients with early adenocarcinoma of the esophagus. However, such treatment is associated with substantial morbidity and compromised quality of life. Limited resection, minimal invasive surgical procedures or endoscopic mucosal ablation have been proposed as less invasive alternatives. A comparison of treatment-associated morbidity, recurrence rate, long-term survival and functional outcome suggests that none of these alternative methods can be universally recommended. An individualized strategy should be employed based on staging (tumor penetration into the mucosa/submucosa, presence of lymph node metastasis), multicentricity of tumor, length of the underlying Barrett's mucosa and risk factors of the affected patient. Surgical resection (radical or limited) remains the treatment of choice for tumors invading the submucosa, multicentric tumor growth and recurrence after endoscopic mucosectomy.

Aim: The aim of this study was to compare the efficiency of the preoperative combined chemo-radiotherapy in the treatment of locally advanced squamous cell carcinoma in different locations of the oesophagus., Methods: Between 1997 and 2005, 102 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy. In 40 cases, the tumour was localised in the upper-third (Group I), while in 62 cases, in the middle-third of the oesophagus (Group II). Survival rates of patients receiving neoadjuvant therapy were compared with a historical control group. In addition, Group I and Group II were compared to each other, as well., Results: survival rate was significantly better after neoadjuvant therapy (p:0.0042) Resection was performed in 70% of the patients from Group I, and in 50% of those complete pathological remission (pCR) was observed. The perioperative morbidity and mortality rates were 43% and 14%, respectively. As far as Group II, 69% of the patients underwent oesophageal resection, with a perioperative mortality of 18% and morbidity rate of 62%. pCR was observed only in 7% of the cases. The median survivals (21 and 22 months) and the R0 resection rates (82 and 84%) were similar in the two groups. The pCR subgroup showed a significantly better survival rate., Conclusion: In this study, we demonstrated that preoperative chemo-radiotherapy increases survival in locally advanced oesophageal cancer. A significantly higher rate of complete response was observed in patients with upper-third oesophageal cancer. It seems that this group has superior sensitivity to multimodal treatment; therefore, our results support a new prognostic factor in oesophageal cancer treatment.

We performed 26 reconstructions after emergency esophago-gastrectomy for corrosive injury during 13 years (1992-2004). Substernal replacement with pedicled colon graft was performed in 22 patients. Multi-stage operations were performed in 4 patients, two free jejunal grafts were applied after unsuccessful colon replacement. In two patients reconstruction could be completed only with a skin tube. Two patients died in the postoperative period. We do not support one stage reconstruction in corrosive injuries, and we suggest that the ideal time for reconstruction is around two months after esophago-gastrectomy.

Pharyngo-laryngo-esophagectomy in the treatment of advanced tumors of the pharyngo-esophageal junction is associated with a high morbidity and poor quality of life due to loss of the larynx. Neoadjuvant chemoradiotherapy resulted in a considerable tumor reduction in 6 patients allowing radical tumor resection by larynx-preserving pharyngo-esophagectomy. The operation consisted of total esophagectomy and resection of the posterior pharyngeal wall and reconstruction by a pharyngogastrostomy in 5 patients, and ileocolon interposition in 1 patient.

Unlabelled: Pharyngo-laryngo-esophagectomy has been the sole surgical option in the management of advanced tumors arising from the pharyngoesophageal junction. This operation is associated with high morbidity, mortality and poor quality of life due to loss of larynx. The aim of the author was to achieve a reduction in tumor size by means of neoadjuvant chemoradiotherapy and so to make the tumor amenable to a larynx preserving operation avoiding pharyngo-laryngo-esophagectomy. Between 1. January 1998 and 31. December 1999, 11 consecutive patients with advanced cancer of pharyngo-esophageal junction were treated with neoadjuvant chemoradiotherapy (carboplatin, 5-fluorouracil, 30-35 Gy telecobalt irradiation). The tumor regressed in all cases and moreover, in 6 patients a larynx preserving pharyngo-esophagectomy could be carried out. This operation consists of total esophagectomy, resection of posterior pharynx wall and Akiyama-type gastric pull up with side-to-side pharyngo-gastrostomy. All 6 patients recovered. In 2 cases after neoadjuvant therapy the tumor disappeared from the cervical esophagus and so that a pharyngo-laryngectomy and free jejunum transfer could be performed. 3 other patients remained irresectable due to lymph node metastases., Conclusion: Larynx preserving pharyngo-esophagectomy is a safe operation by means of which the larynx can be preserved even in those patients whose tumor is located at the level of pharyngo-esophageal junction, on the posterior wall of the pharynx.

Two cases of neoesophago-tracheal fistula are described. After esophagectomy for cancer a fistula developed between the trachea and the pulled-up stomach probably because of the ischaemic effect of the tracheostomy tube. At single stage repairs, the fistulae were divided and the gastric defects were closed directly. In one case, tracheal resection and anastomosis was necessary. The defect on the membranous trachea in both cases was patched with an autologous fascia lata graft. A left pectoralis major muscle flap was interposed between the suture lines to prevent recurrence of the fistula. Treatment of this potentially life-threatening and rare condition yielded excellent results.

Two successfully managed cases of esophageal replacement for cancer complicated by neoesophagotracheal fistula are described. In both cases radical esophagectomy with a gastric pull-up was performed. In the postoperative period different complications necessitated prolonged ventilatory support and tracheostomy. In both cases a tracheo-gastric fistula developed probably because of the ischaemic effort of the tracheostomy tube and the nasogastric tube. At single stage repairs, the fistulae were divided and the gastric defects were closed directly. In the first case resection of four strictured tracheal rings and tracheal anastomosis had to be performed. In the second case the fistula was recognized earlier and stricture did not develop. The defect on the membranous trachea was patched with autologous fascia lata graft. A left pectoralis major muscle flap was interposed between the trachea and the pulled up stomach in both cases to prevent recurrence of the fistula. Treatment of this potentially life-threatening and rare condition yielded excellent results.

Authors have performed 266 one-stage resections and 6 reversed two-stage operations for the treatment of esophageal cancer during a 10-year-period. In six cases first a substernal bypass with colon or stomach was carried out while the tumourous esophagus was removed only 3-4 weeks later from a right thoracic approach. All six patients recovered. The reverse two-stage operation for esophageal cancer can be suggested with rare indications (pulmonary abscess, previous abdominal operations, severe malnutrition, etc.) and it is only justified when the advantage gained by increased operability and decreased morbidity and/or mortality is higher than the disadvantage ensuing from oncological, financial and patient demanding considerations.