Patient N.M.T (male, born in 1974, Long An) was hospitalized due to difficulty swallowing. This is a case of a patient diagnosed with stage IVB hypopharyngeal cancer, the tumor spread above to the oropharynx, down to the cervical esophagus, forward to the trachea - thyroid cartilage, back to the prevertebral fascia and metastasized to the cervical lymph nodes on both sides.
The patient underwent surgery to completely remove the pharynx - cervical esophagus - larynx, thyroid cartilage, prethyroid muscle into one block and bilateral neck lymph nodes. After that, the doctors coordinated with the Department of Thoracic - Abdominal Surgery, Department of Head and Neck - Maxillofacial Surgery of Ho Chi Minh City Oncology Hospital (branch 2) to remove the jejunum (small intestine) with double vascular pedicles according to the technique updated from Osaka International Cancer Institute. In order to achieve a 100% success rate like in Japan, the plastic - microsurgical team performed sutures to connect the two vascular pedicles, then reconstructed the pharynx - cervical esophagus with a free jejunal flap.
After surgery, the patient was closely monitored every 2-3 hours for the first 72 hours and every 6 hours for the next 5 days. During the recovery process, the patient underwent physical therapy and daily nutritional check-ups. After 18 days of treatment, the surgical wound healed well and the patient was able to drink water.
Associate Professor, Dr. Nguyen Anh Khoi - Head of the Department of Surgery - Head and Neck - Maxillofacial, Ho Chi Minh City Oncology Hospital - said: "We conducted a CT scan with contrast agent, the results showed that the reconstructed digestive tract was functioning well, with no signs of leakage in the reconstructed pharynx - esophagus. It is expected that the patient will be transferred to the department for radiation - chemotherapy to prevent the disease from recurring."
Hypopharyngeal cancer accounts for about 3 - 4% of head and neck cancers. About 77% of cases are hospitalized at stage IV, the disease has the worst prognosis of all cancers in this region, with a 5-year survival rate of only about 35%. The disease is characterized by multifocal goiter, submucosal spread and early cervical lymph node metastasis. Treatment is a combination of many specialties including: cancer surgery - plastic surgery, radiotherapy, medical oncology, diagnostic imaging, rehabilitation and nutrition. Surgery is recommended with a wide resection of 2 - 3 cm, so the defect is often very large, occupying the entire circumference of the pharynx - esophagus.
According to Dr. Anh Khoi, after surgical treatment, reconstructive surgery is required to restore the patient's basic life functions. This is a very complicated surgery that can only be performed at cancer centers with full specialties and modern equipment.
