Advanced Laryngopharyngeal Cancer – Swallowing and Vocal Rehabilitation by Radical Surgery & Modified Blom Singer Technique

Laryngopharynx is funnel-shaped, wider above & has rich lymphatic supply. These two points are very significant in the management of cancers in this region. These patients present very late, usually in a very poor general condition, often with lymph node metastasis. Many such patients are not fit for major surgery. Advanced cancers can be treated by radical surgery like total laryngopharyngoesophagectomy which solves the swallowing problem. By creating a fistula between the stomach and trachea using a modified Blom-Singer technique, the patient will develop good gastric speech. Radical neck dissection & surgery for thyroid involvement can be combined with the main operation. Gastric pull-up was thought to be not possible earlier. The oesophagus is mobilized by blunt finger dissection from above and from below. Two teams of surgeons operate at the same time, one for the neck for doing total laryngopharyngotomy and, if necessary, radical neck dissection. The second team operates in the abdomen to mobilize the stomach, keeping the right gastroepiploic artery pedicle. Duodenum is mobilized & cocherisation is done. Pyloroplasty is done for drainage purpose. The neck surgeon, by blunt finger dissection, mobilizes the upper part of the thoracic oesophagus and trachea. The abdominal surgeon, by blunt finger dissection, mobilizes the lower oesophagus. Now the two teams work together and the stomach is pulled into the neck through the posterior mediastinum. By bringing the stomach to the neck through the posterior mediastinum, this technique works well, and the stomach, acts as a tamponade to prevent any bleeding in the mediastinum. By using Gluck-Sorensen's incision in the neck, the resulting scar is cosmetically acceptable. In course of time, this method has been used in many centers including ours.