ABSTRACT

In total pharyngolaryngoesophagectomy (TPLE), after the larynx, hypopharynx, and cervical esophagus have been excised, the food passage is reconstructed with a free jejunum ¬ap, and a permanent tracheostoma is prepared (Figure 24.2). Resection of the larynx permanently disables phonation by means of the vocal cords, but the permanent tracheostoma enables tube-free airway control. The ability to intake food orally is restored by reconstructing a pathway from the pharynx to the upper gastrointestinal tract. Tumor ulceration, bleeding, and foul odors tend to decrease QOL (Azuren et al. 1997). TPLE may control bleeding, pain, and odors from the primary lesion. In contrast, a well-prepared permanent tracheostoma causes no such problems and restoration of oral intake ability maintains the pleasure of eating. Therefore, TPLE markedly improves QOL and increases the chances that the patient can be cared for at home. Many palliative surgeries, such as bypass surgery, have been reported for the treatment of obstruction caused by cancers of the digestive tract.