Before the introduction of this technique, patients were compelled to resorting to parenteral nutrition, with the consequent reduction in their quality of life.
Neck cancer is not counted among the tumors with a high mortality rate, but is among those whose treatment may have lasting effects on the lives of patients. Given the degree of invasiveness of the surgery needed to remove the tumor and the complexity of post-surgery reconstruction, the aggressiveness of which is directly related to the size of the tumor, “the patient may have difficulty swallowing for some time or even for the rest of his/her life”, points out Dr. Eduardo Raboso, head of ENT at MD Anderson Cancer Center Madrid.
Therefore, gastric pull-up surgery would seem to be a better alternative in terms of safety and quality of life for “patients with tumors of the pharynx, larynx or thyroid gland requiring aggressive resection and for whom there is no other reconstruction option”, states Dr. Raboso.
As Dr. Oscar Alonso, specialist in Gastrointestinal Surgical Oncology at MD Anderson Madrid explains, gastric pull-up is a “reconstruction technique used on the digestive tract consisting of using the wider curve of the stomach to construct a tube we pull up through the posterior mediastinum, where the esophagus would lie, to the neck, or more specifically to the remains of the pharynx or even to the base of the tongue”. So, the usual problems with swallowing are avoided and the patient can take food by mouth after a few days.
Traditionally, specialists in Gastrointestinal Surgical Oncology use the technique to treat cancer of the esophagus. The novelty lies in using their experience to treat patients with large neck tumors and/or those that have spread to other structures. The only difference between operating neck cancer patients and those with cancer of the esophagus is where the connection is made, which in the latter is made at the cervical esophagus or upper thoracic esophagus.
Indeed, the surgical intervention of these patients requires the presence of both specialists. So, as explained by the head ENT at MD Anderson Madrid, “general surgeons are in charge of tubulizing the stomach to bring it up through the thorax, whilst we remove the tumor and connect the stomach to the remaining part of the pharynx or to the base of the tongue”. A complicated process these professionals achieve in a single surgical procedure lasting between 8 and 10 hours.
However, despite being a well-known technique, there are very few professional groups specialized in carrying out gastric pull-up, as it is a complex procedure and indicated in few cases and for which the collaboration of specialists in ENT and Gastrointestinal Surgical Oncology is required during the procedure and then, of specialists in Medical Oncology and Radiation Therapy to administer chemotherapy and radiotherapy when necessary.
After surgery, the patient stays in hospital for two or three weeks, when his/her eating pattern is also gradually normalized. As Dr. Alonso point out, “after a few days and when everything is healing well, the patient begins taking purees, then semi-solid foods and finally solid foods, so that he/she ends up eating practically everything, as long as the food is soft and easy to chew”.
The only indication is that the diet be broken up, i.e. divided into five small meals a day instead of three. This is a very satisfactory result, considering that the patient would otherwise have to be fed intravenously and wear a tube connected to the stomach with the consequent effects on his/her quality of life”, stresses the doctor. Furthermore, the technique has been proven to be very safe in spite of the complexity of the procedure and Dr. Raboso describes “the occasional salivary fistula” as the only complication.
For the moment, MD Anderson Madrid has already carried out the procedure successfully on several patients, one of whom had cancer of the thyroid gland and had been refused surgical treatment at other centers, and another with very serious pharyngeal-laryngeal cancer with very limited treatment options. The challenge now, says Dr. Raboso, is “to go on working and trying out the technique on other types of neck tumor”.