Objective: Cancer of the pharyngo-esophageal junction (PEJ) is associated with a late onset of symptoms, high morbidity and a dismal prognosis. Radical surgery with circumferential pharyngo-laryngectomy and reconstruction with a free vascularized jejunal transplant has been increasingly practiced in the treatment of these patients. This strategy is not devoid of per- or postoperative challenges and there is a need for objective tools to evaluate the clinical outcome after these operations. The present study aimed at evaluating long-term outcome, including quality of life, speech valve- and swallowing functions using radiological technique, among patients who have undergone such surgical treatment due to cancer of the PEJ.
Material and Methods: Ten patients (mean age 59) with a follow-up time since surgery ranging from 6 to 130 months (mean 54 months) were included. Clinical assessment, health-related quality of life (HRQL) questionnaires and a standardized radiography protocol was used for evaluation.
Results: At follow-up, Karnofsky Performance Score ranged from 60-90 (mean 82). The speech valve function, based on the degree of usage, was assessed as moderate (n=3) to poor (n=3). Global health status/QL scores (EORTC QLQ-C30) had a mean value of 74, whereas mean scores for the dysphagia related scales and items of the EORTC QLQ OES-18 questionnaire were all within the lower range. Radiographical signs of disturbed bolus transport through the jejunal transplant and the remaining native esophagus were found in all patients examined, in spite that the grade of dysphagia according to Ogilvie et al. was 0-1, while Watson Dysphagia Score varied between 0.5 and 25.5 (mean 10.5). No correlation was found between radiographic findings and clinical assessment or outcome from the HRQL questionnaire.
Conclusion: HRQL were generally good after surgical treatment due to cancer of the PEJ, with mild dysphagia but a moderate to poor speech valve function. Radiological signs of disturbed bolus passage after free jejunal reconstruction were common but the clinical impact of this seemed to be low.