Nutrition and Palliative Surgery for Head and Neck Cancer

Authored by: Takeshi Shinozaki

Handbook of Nutrition and Diet in Palliative Care

Print publication date:  July  2019
Online publication date:  July  2019

Print ISBN: 9781138064072
eBook ISBN: 9781315160627
Adobe ISBN:

10.1201/9781315160627-22

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Abstract

As head and neck cancer progresses, it may cause airway and esophageal obstruction, which may necessitate tracheostomy and gastrostomy or central venous nutrition. These procedures markedly decrease patients’ quality of life, and many patients want to maintain oral intake for as long as possible. In total pharyngolaryngoesophagectomy, after the larynx, hypopharynx, and cervical esophagus have been excised, the food passage is reconstructed with a free jejunum flap, and a permanent tracheostoma is prepared. Resection of the larynx permanently disables phonation with the vocal cords, but the permanent tracheostoma enables tube-free airway control. We performed total pharyngolaryngoesophagectomy as palliative surgery for two patients. Both patients were satisfied with the outcomes of the surgery. The aims of surgical treatment should be to improve symptoms, minimize postoperative complications, and shorten the duration of hospitalization. The indications for palliative surgery should be determined on the basis of an overall evaluation of patient satisfaction and potential risks. Total pharyngolaryngoesophagectomy may be appropriate for selected patients depending on the basis of the location and speed of advancement of lesions, the patient's general condition and living environment, and in accordance with their wishes and religious and personal beliefs. The route of nutritional intake (nasogastric tube versus percutaneous gastric tube) might be predictive for the duration of hospital stay.

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