Minimally invasive total pharyngo-laryngo-esophagectomy as a salvage procedure, technical notes and outcomes from a multidisciplinary team approach

Total pharyngo-laryngo-esophagectomy (TPLE) represents the main salvage surgical procedure for cervical oesophageal cancer involving the hypopharynx after failed definitive chemoradiation (CRT). It is an extremely extensive, technically challenging, and high-risk procedure. We report a series of totally minimally invasive transthoracic TPLEs with gastric pull-up reconstruction in a referral center for esophageal surgical oncology. We retrospectively reviewed medical records of all patients undergoing TPLE in our institution from January 2018 to March 2024 from a prospectively collected database. The operations were performed by two teams of esophagogastric surgeons and otolaryngology head and neck surgeons. Fourteen patients underwent TPLE during the study period. Indications were salvage surgery for squamous cell carcinoma (SCC) of the cervical esophagus involving the hypopharynx, which was persistent/recurrent after CRT in 10 patients (71.4%) and a second primary tumour in 3 patients (21.4%), and surgery for thyroid cancer involving the larynx and the cervical esophagus in one case (7%). Median age at surgery was 64 years (range 41-80). In-hospital mortality was 0%, major complications rate (Clavien-Dindo >= 3a) was 43%, anastomotic leak rate occurred in 3 patients (21.4%), mean length of hospital stay was 36 days (17-86). Eight patients (57.1%) were alive and disease free with a median follow-up time of 16 months (2-67). Salvage transthoracic totally minimally invasive TPLE, despite the high morbidity, is feasible and safe when performed by a multidisciplinary surgical team and can be curative for persistent or recurrent cancer of the pharyngoesophageal junction after definitive CRT.