Complication following gastric pull-up reconstruction for advanced hypopharyngeal or cervical esophageal carcinoma: a 20-year review in a Chinese institute.

OBJECTIVES: Carcinoma of the hypopharynx and cervical esophagus is a very aggressive cancer with a high incidence of multifocal mucosal involvement and a high incidence of submucosal lymphatic spread. Total pharyngolaryngoesophagectomy and gastric pull-up reconstruction are often the procedures of choice. The aim of this study is to review the complication after gastric pull-up reconstruction in patients with advanced hypopharyngeal or cervical esophageal cancer. MATERIALS AND METHODS: A total of 208 patients undergoing gastric pull-up reconstruction for squamous cell carcinoma of the hypopharynx invading the cervical esophagus and cervical esophagus at the Affiliated Provincial Hospital of Anhui Medical University in China from 1988 to 2007 were reviewed. Of 208 patients, 124 patients had hypopharyngeal carcinoma invading cervical esophagus; and 84 patients had cervical esophageal carcinoma. The analysis focused on the most common complications and the survival following gastric pull-up reconstruction. This study and its methods have been approved by the institutional review board. RESULTS: Of the 208 patients, 87 (41.8%) developed some complications, including anastomotic leak (19, 9.1%), pneumonitis (23, 11.1%), pleural effusion (15, 7.2%), wound infection (8, 3.9%), heart failure (4, 1.9%), anastomosis stricture (7, 3.4%), chylous fistula (4, 1.9%), hemothorax (3, 1.4%), hemoperitoneum (2, 1.0%), and burst abdomen (2, 1.0%); there was no gastric necrosis. In our cases, there was no immediate operative mortality; but there were 4 hospital deaths. The average hospital stay was 15 days. CONCLUSIONS: Gastric pull-up reconstruction is a relatively safe and effective method and can be performed with low mortality and acceptable morbidity and result in good quality of lives.

Rigid bronchoscopy for inhaled pen caps in children.

PURPOSE: The aim of this study was to present the clinical findings and treatment of pen cap inhalation with emphasis on the importance of managing aspirated foreign bodies by rigid bronchoscopy. METHODS AND PATIENTS: Of 1280 patients with foreign body inhalation treated from 1997 to 2007, 34 (2.65%) were because of pen cap inhalation. Medical records of these 34 patients were retrospectively reviewed and analyzed for age, sex, symptoms, location of pen cap, treatment, complications, and outcomes. RESULTS: Of the 34 children with pen cap inhalation, 22 (64.7%) were boys and 12 (35.3%) were girls. They ranged in age from 6 to 14 years, pen caps were most frequently found in the right main stem bronchus (26 cases, 76.4%). A history of an episode of foreign body inhalation (34 cases, 100%) and acute cough (28 cases, 82.3%) were the most common presenting findings. All inhaled pen caps were successfully removed by reverse grasping forceps during rigid bronchoscopy. Tracheotomy, thoracotomy, and bronchotomy were not performed in any patients. There were no severe complications or deaths. CONCLUSIONS: Pen cap inhalation mostly occurs in school-aged children. Patients usually can depict a clear history of pen cap inhalation, which is vital to early diagnosis. Inhaled pen caps can be removed safely by rigid bronchoscopy under general anesthesia combined with topical anesthesia. Open surgical techniques such as tracheotomy, thoracotomy, and bronchotomy can be avoided in most cases. More attention to programs of prevention, public and parent education, and awareness is needed to reduce the incidence of pen cap inhalation.