Chapter 120 - Esophageal Cancer

Gastric pull up is the reconstruction method that gives the highest rate of return to oral feeding.

A long-standing history of ETOH (alcohol) and tobacco use with mild dysphagia poses the greatest risk of esophageal cancer. Both alcohol and tobacco are known risk factors for developing esophageal cancer. Dysphagia, or difficulty swallowing, can also be a symptom of esophageal cancer. Therefore, the combination of these factors increases the likelihood of developing esophageal cancer compared to the other options provided.

A circumferential esophageal tumor that is 3 cm in size is classified as T2 stage. In the TNM staging system for cancer, T2 stage indicates that the tumor has invaded the muscularis propria layer of the esophageal wall. This means that the tumor has grown beyond the inner lining of the esophagus and into the deeper layers of the organ. The size of the tumor (3 cm) is also a factor in determining the stage, with T2 stage typically indicating tumors larger than 2 cm but not larger than 5 cm.

The correct answer is T3N1. This is because the tumor is measuring 4cm, which indicates a T3 stage. The presence of unilateral palpable lymphadenopathy suggests regional lymph node involvement, leading to an N1 stage.

A colon transposition graft is a surgical procedure where a segment of the colon is used to replace or reconstruct a damaged or diseased part of the urinary tract. This procedure involves significant risks and potential complications, leading to higher morbidity and mortality rates compared to the other options listed. The surgery carries the risk of infection, anastomotic leaks, bowel obstruction, and other complications associated with major abdominal surgery. Therefore, the colon transposition graft has the highest morbidity and mortality rates among the given procedures.

The correct answer is Total laryngopharyngectomy with cervical esophagectomy. This surgical modality involves the removal of the entire larynx and pharynx, along with the cervical esophagus. Since the tumor involves the postcricoid mucosa, which is located in the laryngopharynx, this surgical approach is the most appropriate. Wide excision with negative margins may not be sufficient to remove the entire tumor, and cervical esophagectomy alone may not address the involvement of the postcricoid region.

Chemotherapy does not provide a significant increase in survival compared to best supportive care in metastatic disease.

The radial forearm free flap is the most susceptible to ischemic injury. This is because the flap relies on the radial artery as its main blood supply, which is a small vessel with limited collateral circulation. If there is any compromise to the radial artery, such as thrombosis or spasm, it can lead to inadequate blood flow to the flap and subsequent ischemic injury. Additionally, the radial forearm flap has a relatively thin and delicate skin paddle, making it more prone to ischemic damage compared to other flaps.